You can select your prefered subtitle language by using the  CC  button in the player control bar.

Breakthrough in otitis: no oral antibiotics in children with ear tubes and acute otorrhea

MD-FM Thursday February 20, 2014

 

SARAH:

MD-FM, Medical News from around the world with Peter Goodwin.

SEGMENT 1: OTITIS: topical antibiotics far more effective and safe than oral antibiotics in children with acute tympanostomy-tube otorrhea

  

PETER:

Hello, and Sarah Maxwell is here with me. And, to begin with, topical antibiotics –rather than systemic ones –should be used to treat otorrhea in children who’ve been fitted with ear tubes.

 

SARAH:

Yes, that’s according to the conclusions of a randomized trial conducted in Europe which confirms recent guidelines put forward by the American Academy of Otolaryngology - Head and Neck Surgery. The results –published in the New England Journal of Medicine –are clear-cut. First study author Dr. Thijs van Dongen:

 

VAN DONGEN:

After two weeks, five per cent of children who were treated with eardrops still had ear discharge, as compared to 44 per cent of the children treated with oral antibiotics and 55 per cent of the children managed with initial observation –so it’s quite a big difference.

 

SARAH:

Thijs van Dongen, from the University of Utrecht in the Netherlands. Not only do topical antibiotics work better and faster, they also have fewer side effects and, most importantly, are much less likely to be defeated by antibiotic resistance. Dr. Richard Rosenfeld, who didn’t participate in the study:

 

ROSENFELD:

It has to do with the concentration: if you put an antibiotic in directly through the ear canal, the concentration is about a thousand times more than what you get through the blood. So, it basically kills all the bacteria, even the ones that could be resistant potentially. There’s a saying that goes: “Dead Bugs Don’t Multiply” –if you kill all the bacteria, there’s nothing left to be resistant, basically.

 

SARAH:

That was Richard Rosenfeld, Professor and Chairman of Otolaryngology at the State University of New York. And he told us that despite recent recommendations, many physicians still use oral antibiotics to treat these patients:

 

ROSENFELD:

I don’t know why... But it falls under the heading: if 50 million people do a foolish thing, it’s still a foolish thing. I know, from just seeing a lot of kids who have this problem in my practice, that parents are often given oral antibiotics by very good pediatricians, who think they’re treating just another type of ear infection! So the message hasn’t gotten out yet to a lot of the primary care and emergency community, at least in the US, that, hey, this is the way to do it!

 

SARAH:

Richard Rosenfeld, from New York.

 

SEGMENT 2: Is medical management alone better than removing unruptured brain arteriovenous malformations? The controversy continues

 

PETER:

The controversy continues about how best to manage patients with unruptured brain arterio-venous malformations, with a first comparative study, funded by the National Institutes of Health, reporting that medical management alone is better than performing any kind of intervention to remove the AVM.

 

SARAH:

Yes: after a follow-up of about three years, the risk of death or stroke was four to five times higher in patients randomized to neurosurgery, embolization, and/or stereotactic radiotherapy compared to those on medical management alone. These findings, based on 223 patients, are published in the New England Journal of Medicine. Co-author Professor Christian Stapf, from Paris:

 

STAPF:

If you live with an AVM in your brain, you are at very very low risk of having a stroke, but it’s not zero. This risk increases dramatically when you touch the malformation and so, at the current stage, I think we have no scientific justification to offer preventive eradication to a patient with an AVM that never has hemorrhaged in the past. I think preventive eradication is no longer justified.

 

SARAH:

Some experts are still not convinced; and they criticize several aspects of the study, including: patient-selection, the type of intervention offered to patients and, especially, the fact that the study’s only been followed up in the short-term. But Dr. Stapf responded that their hands had been tied:

 

STAPF:

We had hoped to follow patients longer, to get an even better understanding of the natural history, but the recruitment was stopped after an average of three years of follow-up, by the data safety monitoring board, because of an excess risk of death and stroke in the interventional arm. I think the non-outspoken reason for the controversy is, especially in the US, the enormous income for institutions and doctors related to the treatment.

 

SARAH:

Christian Stapf, from France.

 


SEGMENT 3: Systolic blood pressure variability predictor of poor outcomes in patients with acute intracerebral hemorrhage

 

PETER:

When you find an intra-cerebral hemorrhage, it’s important to reduce high systolic blood pressure rapidly, right after hemorrhage onset, and to make sure it stays controlled for several days. These are the recommendations made by the authors of a randomized trial published in The Lancet Neurology, which showed that the greater the systolic blood pressure variability after a brain hemorrhage, the stronger the association with poor outcomes at 90 days, and that’s independently of mean systolic pressure.

 

SEGMENT 4: Catheter ablation is a reasonable first-line option for paroxysmal atrial fibrillation

 

PETER:

In patients with paroxysmal atrial fibrillation, catheter ablation –which is currently only recommended second line, when anti-arrhythmic drugs haven’t worked –could, apparently, be a reasonable first-line option...

 

SARAH:

Yes, at two years, ablation was significantly better than drugs at reducing the number of recurrences and delaying the next episode in a study published in the Journal of the American Medical Association. Lead author Carlos Morillo, gave us the details:

 

MORILLO:

There was a 44 per cent relative risk reduction in the group that was randomized to the ablation compared to the group that received anti-arrhythmic drugs. So, in other words, the ablation treatment was superior to the antiarrhythmic drugs. 

 

SARAH:

That was Dr. Carlos Morillo, from McMaster University in Hamilton, Ontario. But ablation wasn’t curative: about a half of the patients still had recurrences.

 

PETER:

What about side effects?

 

SARAH:

Well catheter ablation isn’t a risk-free procedure! There weren’t any reports of death or stroke but major complications occurred in nine per cent of patients randomized to ablation, compared with five per cent in those on drugs. Dr. Morillo considered that to be a low complication rate. And overall, Dr. Morillo told us, ablation is probably also better at reducing the progression of atrial fibrillation:

 

MORILLO:

One of the things that happens with atrial fibrillation is that everybody starts by having intermittent episodes but then when it becomes chronic it’s too late. So, probably, trying to intervene at an earlier stage, in patients who are around 50 years old, is better than having to wait and giving them one drug then another because, then, the atrial fibrillation is progressing.

SARAH:

Carlos Morillo, from McMaster University in Hamilton, Canada. Lets add that: while these results are enticing, the approach might be difficult to implement since the number of practitioners who actually perform catheter ablation is still limited in countries like France.

 

SEGMENT 5: Patients complaining of flatulence have an unstable gut microbiota


PETER:

Patients complaining of excessive flatulence could have unstable microbiotas, and researchers are looking for ways to remedy this problem…

 

SARAH:

Yes the first trial to use genetic sequencing to examine the relationship between diet and the intestinal microbiota of patients complaining of excessive flatulence has just appeared in the journal GUT. Firstly, the investigators showed that patients had a different microbiota composition from healthy controls with different species of bacteria present. After eating a high flatulogenic diet –rich in residues and difficult to digest –patients and controls all had more flatulence. First author Chaysavanh Manichanh told us that while the microbiota in healthy controls remained stable, in unhealthy patients it varied:

 

MANICHANH:

The variation in the microbial composition was much higher in the patients compared to healthy individuals so it means that they have a very unstable microbiota and they were not able to maintain a kind of homeostasis in their microbiota after the flatulogenic diet.

 

SARAH:

Dr. Chaysavanh Manichanh, from Barcelona, who told MD-FM she thought eating a low flatulogenic diet can help some patients resolve their problem, but that the long-term effects of doing that are unknown. Her colleague, Fernando Azpiroz, gave us more on this:

 

AZPIROZ:

This diet is difficult to follow in the long run and, even if in the short run the effect of the diet is beneficial, in terms of symptoms, in the long run this diet might impoverish the microbiota and might result in long-term damage. The alternative is to try to modify intestinal microbiota either with pre- or probiotics and we don’t know which one is best.

 

SARAH:

That was senior author Dr. Fernando Azpiroz, also from Barcelona, whose team is now investigating these alternatives and also fecal transplantation.

 

IN BRIEF 1: Thrombotic risk remains mildly elevated beyond the 6-week postpartum period

 

PETER:

Finally, in brief: The risk of thrombosis after delivery apparently persists until at least 12-weeks –so beyond the well-known high-risk ‘postpartum period’ of 6 weeks. These are the findings of a study, published in the New England Journal of Medicine, based on data analysis from over 1.6 million women. The authors note, however, that the absolute increase in risk beyond the postpartum period is low. And …

 

IN BRIEF 2: Home-based exercise program improved recovery following rehabilitation for hip fracture

 

PETER: A six-month home-based exercise program requiring minimal supervision, including exercises such as standing from a chair or climbing a step, improved recovery following rehabilitation for hip fracture, according to findings published in JAMA. The authors suggest this approach could be introduced to patients after completing their traditional physical therapy to provide a more effective way to continue exercising in their own homes.

 

PETER:

That’s all for from this week’s MD-FM. Sarah Maxwell and I will be back with more in seven days time. So until then, from me, Peter Goodwin, good-bye!

 

RSS
Twitter
Facebook

Previous editions

Partnership

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
Url
Go to
with
Danone Institute International