Journals Watch - Otitis media, heart failure and CBT

Not had time to read the journals yet? Let Dr Gwen Lewis bring you up to date on the latest research.

Antibiotics were shown to improve symptoms of otitis media in children (Photograph: SPL)
Antibiotics were shown to improve symptoms of otitis media in children (Photograph: SPL)

Acute otitis media in children
N Eng J Med 2011; 364: 105-15

There is much controversy over whether to treat acute otitis media in children with antibiotics.

This interesting study from the US involved 291 children aged six to 23 months who were diagnosed with acute otitis media. They were randomly assigned under stringent criteria to receive 10 days treatment with either amoxicillin/clavulanic acid or placebo and the recovery noted.

Of those receiving antibiotics, 35 per cent had initial symptom resolution by day two, 61 per cent by day four and 80 per cent by day seven. Resolution for those receiving placebo was slower with the percentages being 28 per cent, 54 per cent and 74 per cent respectively. Sustained resolution of symptoms was improved in those prescribed antibiotics.

One child receiving placebo treatment developed mastoiditis while diarrhoea and nappy dermatitis were more common in those given antibiotics.

Candesartan or losartan in heart failure
JAMA 2011; 305: 175-82

ARBs are known to reduce mortality and hospitalisation in patients with heart failure. Different ARBs have different affinity for the angiotensin receptor type-1 and may therefore have different clinical effects.

This Swedish study of 5,139 patients with proven heart failure looked at all-cause mortality in those treated with candesartan and losartan.

A total of 2,639 patients were treated with candesartan and the other 2,500 with losartan. Mortality at one and five years was recorded.

One year survival was 90 per cent for those receiving candesartan and 83 per cent for those on losartan. The five year survival rates were 61 per cent and 44 per cent respectively.

In our PCT, candesartan is the ARB of choice for those patients unable to tolerate ACE inhibitors. Under PCT instruction we are undertaking a review of patients on ARBs and are being encouraged to change patients currently receiving valsartan to losartan. However, this study suggests that we should be using candesartan.

Does CBT help adolescent depression?
Br J Psychiatry 2010; 197: 433-40

Treatment of adolescent depression is controversial and studies of combined treatment with antidepressants and cognitive behaviour therapy (CBT) have produced conflicting findings.

A meta-analysis of RCTs of newer-generation antidepressants and CBT in adolescent depression was undertaken. It found that there was no evidence of statistically significant benefit of combined treatment over treatment with antidepressants alone for depressive symptoms, suicidal ideation and global improvement after acute treatment or at follow-up. However, there was a statistically significant advantage of combined treatment for improvement in the short term (12 weeks only).

These results indicate that antidepressants alone are as effective as drug treatment combined with CBT for long-term treatment of depression in adolescents.

Pandemic influenza in Australia
Med J Aust 2011; 194: 68-72

This study from Western Australia looked at the incidence of infection with pandemic influenza (influenza AH1N1) in the winter of 2009.

Two cross-sectional serosurveys using specimens collected for unrelated pathology testing from before and after circulation of the pandemic virus were undertaken. The results were divided into three groups: those from younger children aged one to four years, those from older children and teenagers aged five to 19 years and those from pregnant women. About 700 samples were analysed. Pre-pandemic samples in those aged one to four years showed no exposure to the virus while in those aged five to 19, 8.3 per cent had been exposed and 4.5 per cent of pregnant women had been exposed. In post-pandemic specimens, estimated infection rates were 25.4 per cent in those aged one to four years and 39.4 per cent in the older age group but only 10.2 per cent in pregnant women.

Just over a quarter of preschool children and almost 40 per cent of older children had serological evidence of pandemic influenza, indicating high levels of asymptomatic infection.

Chlamydia and risk factors
J Fam Plann Reprod Health Care 2011; 37: 10-16

Chlamydia remains common, particularly in the 15-24 years age group where around 10 per cent are found to be positive. At present, partners of infected patients are currently offered 'epidemiological' treatment, meaning that they are given treatment for the infection prior to test results being available.

This study involved 115 chlamydia contacts. As well as being tested for the infection, they completed a questionnaire about their relationship with the index case and their prior sexual history. Of the 115, a total of 60 (52 per cent) were found to be positive for chlamydia. The risk factors for the infection were not surprising: young age, more than one episode of sex with the infected partner and a greater total number of sexual partners.

Attitudes to HPV vaccination
J Fam Plann Reprod Health Care 2011; 37: 22-25

HPV vaccination is offered to girls aged 12-13 years. A one-off programme offered the vaccine to 14-18 year-olds when the programme began. While 88 per cent of girls aged 12-13 years had been vaccinated by September 2009, only 62 per cent of the older age group had received the vaccine. Interviews were carried out with a group of girls aged 17 and 18 years to try to understand why this might be. They were asked about their knowledge of HPV and attitudes towards HPV vaccination.

Most girls were aware that HPV is sexually transmitted but had limited understanding of the infection and HPV vaccination and expressed the need for further information. Some of the girls were uncertain if they needed vaccination if they were not sexually active.

It was concluded that further information should be made available to these girls and that perhaps school-based information might be a useful adjunct to written information.

  • Dr Lewis is a GP in Windsor, Berkshire, 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.

  • Undertake an audit of children diagnosed with otitis media and whether treatment with antibiotics had shortened the duration of the infection.
  • Update yourself on the evidence base for candesartan and losartan and consider if you would change your practice at future medication reviews.
  • Perform a search of those girls in the 17-18 age group to see how many have received HPV vaccination. What further information on HPV infection and vaccination could you provide to this group and how?

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