Journals Watch: Cellulitis and prostate biopsies

Not had time to read the journals? Let Dr Louise Newson bring you up to date on the latest research.

Prophylactic antibiotics may prevent recurrent cellulitis of the leg (Photograph: SPL)
Prophylactic antibiotics may prevent recurrent cellulitis of the leg (Photograph: SPL)

Prophylactic antibiotics for recurrent cellulitis
Br J Dermatol 2012; 166: 169-78

Cellulitis of the leg is common, and repeat episodes can cause significant morbidity and result in high health service costs.

This double-blind, randomised, controlled study assessed whether prophylactic antibiotics prescribed after an episode of cellulitis of the leg can prevent further episodes.

It found that treatment with penicillin reduced the risk of recurrence by 47%. This equates to a number needed to treat of eight participants in order to prevent one repeat episode of cellulitis.

There was no difference between the two groups in the number of participants with oedema, ulceration or related adverse events. Many of my patients would be keen to prevent recurrence of their cellulitis by taking prophylactic antibiotics.

Men's perception of prostatic biopsies
BMJ 2012; 344: d7894

Many of my male patients do not realise that having a prostate biopsy can have associated risks. This study measured the effect of the adverse events within 35 days of transrectal ultrasound-guided biopsy.

This was done from the perspective of asymptomatic men having PSA testing.

A questionnaire was given to patients at the time of biopsy and also at seven and 35 days after their biopsies. Main problems reported were pain, fever, haematospermia and bleeding from the rectum. However, the majority of men did not report these symptoms as being major or even moderate problems.

A negative attitude to a repeat biopsy was associated with an unfavourable experience after their first biopsy.

So although prostate biopsy was demonstrated to be well tolerated by most men, it is associated with significant symptoms in a minority and affects attitudes to repeat biopsy.

Reducing transmission of HSV type 2
Lancet 2012 doi:10.1016/S0140-6736(11)61750-9

Transmission of genital herpes can occur without florid symptoms of herpes. Skin and mucosal herpes simplex virus type 2 (HSV-2) shedding predominantly occurs in short subclinical episodes.

This trial assessed whether standardor high-dose antiviral therapy reduces the frequency of shedding of this virus.

Three groups of patients were involved comparing no medication to aciclovir 400mg twice daily (standard-dose aciclovir); valaciclovir 500mg daily (standard-dose valaciclovir) to aciclovir 800mg three times daily (high-dose aciclovir); and standard-dose valaciclovir with valaciclovir 1g three times daily (high-dose valaciclovir).

Their results demonstrated that the frequency of HSV shedding was significantly higher in the no medication group than in the standard-dose aciclovir group. High-dose aciclovir was associated with less shedding than standard-dose valaciclovir.

This may mean that patients should be given higher doses of antiviral treatment to reduce the likelihood of HSV transmission.

Cardiac complications in community acquired infection
Circulation 2012. doi: CIRCULATIONAHA.111. 040766

Community acquired pneumonia (CAP) is common and can lead to cardiac complications.

In this US study, more than 1,300 inpatients and nearly 1,000 outpatients with CAP were followed for 30 days after presentation.

Incident cardiac complications (new or worsening heart failure, new or worsening arrhythmias or MI) were diagnosed in 26.7% of inpatients and 2.1% of outpatients. The majority of events occurred within the first week.

Factors associated with their diagnosis included older age, nursing home residence, history of heart failure, prior cardiac arrhythmias and previously diagnosed coronary artery disease.

These cardiac complications are associated with increased short-term mortality. Further studies are needed in this area to test risk stratification, prevention and treatment strategies for cardiac complications in this population.

Childhood dyspepsia and anxiety symptoms
Gastroenterology 2012. doi:10.1053/j.gastro.2011.12.043

Dyspepsia is a fairly common symptom in childhood. Currently, little is known about long-term health outcomes of children with dyspeptic symptoms. This study looked at the natural history of paediatric patients (aged eight to 16 years) with dyspeptic symptoms, with and without histologic reflux, compared with healthy controls.

At the start of the study, there was no difference between those with symptoms and healthy controls with regard to depression or anxiety symptoms. After a mean 7.6-year follow-up period, those children who had dyspeptic symptoms were significantly more likely than controls to have an anxiety disorder.

They were also more likely to have chronic dyspeptic symptoms and a reduced quality of life in adolescence and young adulthood.

Low-grade abnormalities found by cervical screening
BJOG 2012; 119: 7-19

If HPV testing replaces cytology in primary cervical screening, the frequency of low-grade abnormal tests will double.

Several available alternatives for the follow-up of low-grade abnormal screening tests have similar outcomes. In this situation, women's preferences have been proposed as a guide for management decisions.

Studies were analysed to review women's preferences for the follow-up of low-grade cervical screening abnormalities. The women were asked to decide between active follow-up or observation for the management of low-grade abnormalities. In all but two studies testing other situations, women more often expressed a preference for active follow-up than for observation. However, women appeared to be more willing to accept observation if they were reassured of the low risk of cervical cancer.

If women continue to prefer active management strategies it may prove to be challenging to meet these expectations of optimal follow-up when HPV testing is used in primary screening.

  • Dr Newson is a GP in the West Midlands and a member of our team who regularly review the journals

Reflect on this article and add notes to your CPD Organiser on MIMS Learning

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Examine the records of your patients who have had at least one episode of cellulitis of their legs in the past year. Discuss with other members of your primary care team about the possibility for any of these patients receiving prophylactic antibiotics.
  • Undergo a search of your patients who have had a prostatic biopsy in the past year. Look at their records to determine whether they reported any adverse events from their procedure.
  • Consider having a meeting with a local GUM specialist to discuss optimal treatment of genital herpes, especially with respect to reducing transmission of this virus.

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