Allergy, URTI and polypharmacy

Too busy to read the journals? Let Dr Lizzie Croton guide you through the latest research.

Breastfeeding and asthma and allergy risk
BMJ, doi:10.1136/bmj.39304.464016.AE

Whether prolonged exclusive breastfeeding protects against asthma is still hotly debated.

This cluster-randomised trial from Belarus enrolled 17,000 mother-child pairs who were part of a successful breastfeeding intervention programme.

Children were followed up 6.5 years later and assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and skin prick tests to five common inhalant antigens.

Children who were exclusively breastfed for at least 12 months showed no reduction in the risk of allergic symptoms, and interestingly showed an increase in reactions to four of the five antigens tested.

Children in Belarus might be less 'allergic' than children in western Europe, but this well-designed study yields some interesting results.

Referrals from GP out-of-hours services
Br J Gen Pract 2007; 57: 706-13

Rates of hospital referral from out-of-hours services vary tremendously among doctors. This qualitative study looked at the factors responsible. The researchers considered the doctors' confidence and experience, attitudes to referral, and history of complaints.

High-referring GPs tended to be anxious about the possible consequences from sending the patient home and held negative attitudes about alternatives to hospital admission.

Low referrers showed more confidence in their decisions and were more positive about alternatives.

They also felt they were better at resisting pressure for admission from relatives and saw hospitals as places to be avoided if at all possible.

Treatment reviews for older people on polypharmacy
Br J Gen Pract 2007; 57: 723-31

The elderly need regular monitoring of their medications because they take more tablets than the majority of the population and are prone to medication-related problems.

This trial randomised 738 elderly people taking at least five medications to one of two styles of treatment review.

In one group, pharmacists and GPs performed case conferences on prescription-related problems. In the other, the pharmacists provided GPs with a treatment review in the form of written feedback.

More medicine changes were initiated as a result of case conferences than written feedback. This difference was also seen six months later but had disappeared by nine months.

The authors conclude that the increased costs of the case conferences were offset by the savings observed with fewer medication changes over time.

Overuse of antibiotics for URTI
Ann Emerg Med 2007; 50: 213-20

Should antibiotics be given or not? Previous research has indicated that doctors often prescribe antibiotics to patients when there is little indication for their use.

This study looked at the use of antibiotics for URTI at 272 attendances in US emergency departments. The doctors were more likely to prescribe antibiotics when they believed that the patient expected them, but were only able to identify 27 per cent of these patients.

Patient satisfaction with the emergency department visit was 87 per cent in those who received antibiotics and 89 per cent in those who did not. Patients were more likely to be satisfied if they left with a better understanding of their illness than clutching a scrip for antibiotics.

The quick study

Breastfeeding failed to lower the risk of asthma and allergy in children at age six years.

Out-of-hours GPs who are confident in their decisions are less likely to refer to hospital.

GPs and pharmacists holding case conferences reduce the number of medication changes for patients on multiple drugs.

URTI patients are more satisfied by improved understanding of their illness than an antibiotic prescription.

Research of the week

Cardiovascular events and rosiglitazone
JAMA2007; 298: 1,189-95

Questions have been raised over the safety of rosiglitazone in patients with type-2 diabetes following a series of adverse events.

This systemic review looked at long-term cardiovascular effects, including MI, heart failure and cardiovascular mortality. The team searched extensively for relevant reports published in May 2007, using MEDLINE, the GSK clinical trials register and the US FDA website.

Randomised controlled trials of rosiglitazone for preventing or treating type-2 diabetes with at least 12 months of follow-up were included. From the study, rosiglitazone appears significantly to increase the risk of MI without a significant increase in cardiovascular mortality.

Dr Croton, a GP registrar in Birmingham 

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