Tag Archives: Medical research

Rule that patients must finish antibiotics course is wrong, study says

Experts suggest patients should stop taking the drugs when they feel better rather than completing their prescription

Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned.

Patients have traditionally been told that they must complete courses of antibiotics, the theory being that taking too few tablets will allow the bacteria causing their disease to mutate and become resistant to the drug.

But Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and colleagues claim that this is not the case. In an analysis in the British Medical Journal, the experts say the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.

There are some diseases where the bug can become resistant if the drugs are not taken for long enough. The most obvious example is tuberculosis, they say. But most of the bacteria that cause people to become ill are found on everybodys hands in the community, causing no harm, such as E coli and Staphylococcus aureus. People fall ill only when the bug gets into the bloodstream or the gut. The longer such bacteria are exposed to antibiotics, the more likely it is that resistance will develop.

The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.

In hospital, patients can be tested to work out when to stop the drugs. Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, they say. That, they add, is in direct contravention of World Health Organisation advice.

Other experts in infectious diseases backed the group. I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms, said Peter Openshaw, president of the British Society for Immunology.

This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely.

Alison Holmes, a professor of infectious diseases at Imperial College London, said a great British authority, Prof Harold Lambert, had made the same point in a Lancet article entitled Dont keep taking the tablets as early as 1999. It remains astonishing that apart from some specific infections and conditions, we still do not know more about the optimum duration of courses or indeed doses in many conditions, yet this dogma has been pervasive and persistent.

Jodi Lindsay, a professor of microbial pathogenesis at St Georges, University of London, said it was sensible advice. The evidence for completing the course is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies, she said. The evidence for shorter courses of antibiotics being equal to longer courses, in terms of cure or outcome, is generally good, although more studies would help and there are a few exceptions when longer courses are better for example, TB.

But the Royal College of GPs expressed concerns. Recommended courses of antibiotics are not random, said its chair, Prof Helen Stokes-Lampard. They are tailored to individual conditions and in many cases, courses are quite short for urinary tract infections, for example, three days is often enough to cure the infection.

We are concerned about the concept of patients stopping taking their medication midway through a course once they feel better, because improvement in symptoms does not necessarily mean the infection has been completely eradicated. Its important that patients have clear messages and the mantra to always take the full course of antibiotics is well known. Changing this will simply confuse people.

The UKs chief medical officer, Prof Dame Sally Davies, said: The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.

[The National Institute for Health and Care Excellence] is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics.

The Department of Health will continue to review the evidence on prescribing and drug-resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.

Read more: https://www.theguardian.com/society/2017/jul/26/rule-patients-must-finish-antibiotics-course-wrong-study-says

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Drinking coffee may help prevent liver cancer, study suggests

People who drink more coffee even decaffeinated are less likely to develop liver cancer, an analysis of data from 26 studies has found

Increasing coffee consumption may help to stave off liver cancer, a new study has suggested.

Researchers have found that people who drink more coffee are less likely to develop hepatocellular cancer (HCC), the most common form of primary liver cancer and the effect was even found in decaffeinated coffee.

Experts from the University of Southampton and the University of Edinburgh examined data from 26 studies involving more than 2.25 million participants.

Compared with people who drank no coffee, those who drank one cup a day had a 20% lower risk of developing HCC, according to the study, published in the journal BMJ Open.

Those who consumed two cups a day had a 35% reduced risk and for those who drank five cups, the risk was halved. They found the protective effect for decaf was smaller and less certain than for caffeinated coffee.

The authors wrote: It may be important for developing coffee as a lifestyle intervention in chronic liver disease, as decaffeinated coffee might be more acceptable to those who do not drink coffee or who limit their coffee consumption because of caffeine-related symptoms.

Lead author Dr Oliver Kennedy, of the University of Southampton, said: Coffee is widely believed to possess a range of health benefits, and these latest findings suggest it could have a significant effect on liver cancer risk.

Were not suggesting that everyone should start drinking five cups of coffee a day though. There needs to be more investigation into the potential harms of high coffee-caffeine intake, and there is evidence it should be avoided in certain groups such as pregnant women.

Nevertheless, our findings are an important development given the increasing evidence of HCC globally and its poor prognosis.

Professor Peter Hayes, of the University of Edinburgh, added: We have shown that coffee reduces cirrhosis and also liver cancer in a dose-dependent manner.

Coffee has also been reported to reduce the risk of death from many other causes. Our research adds to the evidence that, in moderation, coffee can be a wonderful natural medicine.

Figures from the Office for National Statistics show that in 2015, 4,673 new cases of liver cancer were diagnosed in England.

Read more: https://www.theguardian.com/science/2017/may/25/drinking-coffee-may-help-prevent-liver-cancer-study-suggests

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Gluten-free diet carries increased obesity risk, warn experts

Food adapted for those with coeliac disease often has more fat and less protein, and no benefits to non-sufferers, finds research

Substituting everyday staples with gluten-free foods could increase the risk of obesity, experts have warned, after finding that such products often contain higher levels of fats than the food they aim to replace.

A gluten-free diet is essential to those with coeliac disease an auto-immune condition that is thought to affect 1% of Europeans while the regime is also proving increasingly popular among those without the disease. But while a host of gluten-free products are on the market, researchers have said they have a very different nutritional make-up to conventional staples.

There is very little [consumers] can do about it, said Joaquim Calvo Lerma of the Instituto de Investigacin Sanitaria La Fe in Spain and co-author of the research. Unfortunately consumers can [only] eat what is available on the market.

Calvo Lermas warning comes after he and his and colleagues compared 655 conventional food products to 654 gluten-free alternatives across 14 food groups including breads, pasta, breakfast cereals, biscuits and even ready meals, covering a range of brands.

The results presented at the annual meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition reveal that, overall, gluten-free products were more energy-dense than their conventional counterparts.

The team found that, on average, gluten-free bread loaves had more than twice the fat of conventional loaves, while gluten-free breads in general had two to three times less protein than conventional products. Gluten-free biscuits were also found to be lower in protein but higher in fat, while gluten-free pasta had lower levels of sugar and just half of the protein of standard pasta.

Calvo Lerma warned that gluten-free foods could be contributing to an increased risk of obesity, particularly among children who are more likely to eat products like biscuits and breakfast cereals. He urged consumers to compare gluten-free products across brands to find those with the lowest fat content.

Calvo Lerma also called on manufacturers to innovate. It is the responsibility of the food industry to produce these type of gluten-free products from other materials that are much healthier or have a [more] enhanced nutritional profile than the current raw materials being used, like cornflour or potato starch, he said, pointing out that healthier products could be made, for example, using grains such as buckwheat or amaranth.

He added that manufacturers should also add more complete and clearer labels to products to highlight their nutritional content, including levels of vitamins and minerals.

Benjamin Lebwohl, from the coeliac disease centre at Columbia University, who was not involved in the research, said that the study backs up previous evidence that gluten-free foods are nutritionally suboptimal. But while a gluten-free diet is essential for coeliacs, it is not intrinsically healthy or unhealthy, he added. It depends on the choices you make as part of the gluten-free diet, he said.

Sarah Sleet, chief executive of Coeliac UK, said the latest findings tie in with the charitys own research, adding that further development of lower-fat, gluten-free products would be welcomed.

David Sanders, professor of gastroenterology at the University of Sheffield, noted that other studies have found gluten-free and conventional foods to have similar nutritional value. The jury is out, he said.

But Sanders cautioned that there is no evidence a gluten-free diet has benefits for those without gluten sensitivity or coeliac disease. Once you go into the territory of dietary restrictions without medical symptoms then you are running the gauntlet of missing out on various vitamins or minerals without realising it, he said.

Read more: https://www.theguardian.com/lifeandstyle/2017/may/11/gluten-free-diet-carries-increased-obesity-risk-warn-experts

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Eating cheese does not raise risk of heart attack or stroke, study finds

Consumption of even full-fat dairy products does not increase risk, international team of experts says

Consuming cheese, milk and yoghurt even full-fat versions does not increase the risk of a heart attack or stroke, according to research that challenges the widely held belief that dairy products can damage health.

The findings, from an international team of experts, contradict the view that dairy products can be harmful because of their high saturated fat content. The experts dismiss that fear as a misconception [and] mistaken belief.

The results come from a new meta-analysis of 29 previous studies of whether dairy products increase the risk of death from any cause and from either serious heart problems or cardiovascular disease. The study concluded that such foodstuffs did not raise the risk of any of those events and had a neutral impact on human health.

This meta-analysis showed there were no associations between total dairy, high- and low-fat dairy, milk and the health outcomes including all-cause mortality, coronary heart disease or cardiovascular disease, says the report, published in the European Journal of Epidemiology.

Ian Givens, a professor of food chain nutrition at Reading University, who was one of the researchers, said: Theres quite a widespread but mistaken belief among the public that dairy products in general can be bad for you, but thats a misconception. While it is a widely held belief, our research shows that thats wrong.

Theres been a lot of publicity over the last five to 10 years about how saturated fats increase the risk of cardiovascular disease and a belief has grown up that they must increase the risk, but they dont.

However, the governments health advisers urged consumers to continue to exercise caution about eating too many products high in saturated fat and to stick to low-fat versions instead.

Dairy products form an important part of a healthy balanced diet; however, many are high in saturated fat and salt. Were all consuming too much of both, increasing our risk of heart disease, said a spokesman for Public Health England. We recommend choosing lower-fat varieties of milk and dairy products or eating smaller amounts to reduce saturated fat and salt in the diet.

Givens and colleagues from Reading, Copenhagen University in Denmark and Wageningen University in the Netherlands analysed 29 studies involving 938,465 participants from around the world undertaken over the last 35 years, including five done in the UK.

No associations were found for total (high-fat/low-fat) dairy and milk with the health outcomes of mortality, CHD or CVD, they said. In fact, they added, fermented dairy products may potentially slightly lower the risk of having a heart attack or stroke.

Doctors, public health experts and official healthy eating guidelines have for many years identified saturated fats as potentially harmful for heart and cardiovascular health and advised consumers to minimise their intake.

That has led to consumers increasingly buying lower-fat versions of dairy products. For example, 85% of all milk sold in the UK is now semi-skimmed or skimmed.

Givens said consumers were shunning full-fat versions of cheese, milk or yoghurt in the mistaken view that they could harm their health. Young people, especially young women, were now often drinking too little milk as a result of that concern, which could damage the development of their bones and lead to conditions in later life including osteoporosis, or brittle bones, he said. Consuming too little milk can deprive young people of calcium.

Pregnant women who drank too little milk could be increasing the risk of their child having neuro-developmental difficulties, which could affect their cognitive abilities and stunt their growth, Givens added.

The most recent National Diet and Nutrition Survey, the governments occasional snapshot of eating habits, found that dairy products, including butter, accounted for the highest proportion of saturated fat consumption in British diets 27%, compared with meats 24%. But if butter was not counted then dairy products together were the second largest source of saturated fat, at 22%.

Saturated fat is a vital part of diet. The NDNS found that adults typically got 34.6% of their total energy from fats as a whole, just below the 35% the government recommends. However, while total fat consumption was just within target, saturated fats still made up an unhealthily large proportion of total food energy 12.6%, against the recommended maximum of 11%.

Givens said: Our meta-analysis included an unusually large number of participants. We are confident that our results are robust and accurate.

The research was part-funded by the three pro-dairy groups Global Dairy Platform, Dairy Research Institute and Dairy Australia but they had no influence over it, the paper said. Givens is an adviser to the Food Standards Agency.

Read more: https://www.theguardian.com/society/2017/may/08/consuming-dairy-does-not-raise-risk-of-heart-attack-or-stroke-study

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Health report links antibiotics to risk of miscarriage

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Canadian study finds taking the drugs raises chances of having a miscarriage by between 60% and 100%

Many common antibiotics may double the risk of miscarriage in early pregnancy, research has shown.

A Canadian study has found that taking the drugs raised the chances of having a miscarriage by between 60% and 100%.

The link was seen with several classes of antibiotic including macrolides, quinolones, tetracyclines, sulphonamides and metronidazole. However, nitrofurantoin, often used to treat urinary tract infections in pregnant women, had no effect on miscarriage risk. Nor did the widely used antibiotic erythromycin.

The researchers looked at data from almost 9,000 cases of miscarriage at an average time of 14 weeks into pregnancy, involving girls and women aged between 15 and 45.

The study leader, Dr Anick Brard, from the University of Montreal in Quebec, said: Infections are prevalent during pregnancy. Although antibiotic use to treat infections has been linked to a decreased risk of prematurity and low birth weight in other studies, our investigation shows that certain types of antibiotics are increasing the risk of spontaneous abortion, with a 60% to two-fold increased risk.

Women who miscarried were more likely to be older, living alone, and to have multiple health issues and infections. But all these factors were accounted for in the analysis, whose findings are published in the Canadian Medical Association Journal.

Dr Brard added: The increased risk was not seen for all antibiotics, which is reassuring for users, prescribers and policymakers.

The researchers identified a total of 182,369 pregnancies from the Quebec pregnancy cohort, a large population group from the province providing data for ongoing studies. Of these, 8,702 (4.7%) ended with an early miscarriage.

Writing in the journal, the team concluded that there was a link between some antibiotics and an increased risk of miscarriage, but added: However, residual confounding by severity of infection cannot be ruled out.

Read more: https://www.theguardian.com/society/2017/may/02/health-report-links-antibiotics-to-risk-of-miscarriage

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Cheap, widely available drug could stop thousands of mothers bleeding to death

Tranexamic acid could save the lives of a third of women who die in childbirth from excessive bleeding, which kills 100,000 a year

A cheap and widely available drug could save the lives of thousands of women who die in childbirth from excessive bleeding, one of the main killers of women worldwide.

The drug, tranexamic acid, is available over the counter in the UK to women suffering from heavy periods. In Japan and the far east, it is used as a skin whitener. But now a very large study of 20,000 women in 21 countries has shown it can stop a third of cases of bleeding to death after giving birth.

Haemorrhage after childbirth kills 100,000 women a year, mostly in low and middle-income countries. It is not only the women dying it is the impact on the child that has to grow up without a mother, children who might already be in the family and the husband, said associate professor Haleema Shakur from the London School of Hygiene & Tropical Medicine who led the trial.

This is of absolutely huge importance. While a single mother is dying, we need to keep fighting for them.

The drug has already been proven to cut the death toll from bleeding after accidents in a trial of similar size. The latest trial, published in the Lancet medical journal, recruited more than 20,000 women who either gave birth in one of 193 hospitals involved or managed to get there after starting to bleed. They were randomly assigned either tranexamic acid or a placebo.

The researchers found that tranexamic acid was most effective when it was given soon after the bleeding began. The trial was originally intended also to find out whether the drug saved women from having to undergo a hysterectomy the removal of the womb. But the scientists discovered that in many countries, where anaemia is common and blood supplies are limited, surgeons operated immediately as the surest way to save the womans life.

If all women who haemorrhage after childbirth were given the drug, the trial suggests that 30,000 lives could be saved a year. In practice, that will be more difficult. Tranexamic acid was given in an intravenous injection in the hospitals, as the quickest way to have an effect. Many women give birth at home and may not get to a hospital in time.

It is available in the form of a tablet for heavy periods, but absorption may take too long, said Shakur. They are now working on new ways to get it rapidly into womens systems perhaps as an injection in the arm muscle or as a capsule under the tongue. It is also possible that women deemed to be at high risk of haemorrhage could be given a tablet before they give birth. The trials have shown no side-effects, making the drug very safe.

Of the two-thirds of women who died in spite of being given the drug, Shakur said some arrived at hospital too late, while others had underlying illness including severe malaria and anaemia which may have been the cause of death.

It has taken a long time to show that the drug does work in the context it was designed for. Professor Ian Roberts from the London School, who co-led the study, said: The researchers who invented tranexamic acid more than 50 years ago hoped it would reduce deaths from postpartum haemorrhage, but they couldnt persuade obstetricians at the time to conduct a trial. Now we finally have these results that we hope can help save womens lives around the world.

There are many next steps, said Shakur. We have to make sure tranexamic acid is available wherever a woman gives birth and is at risk, she said. We must make sure doctors and midwives are aware of the results of the study. And we need health ministers to make sure that the drug is available in their country and is on their shopping list of essential medicines.

Read more: https://www.theguardian.com/science/2017/apr/26/cheap-widely-available-drug-could-stop-thousands-of-mothers-bleeding-to-death-tranexamic-acid

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