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Top 10

The Top 10

What has been happening in the world of pharmacy? Here’s our pick of must-read news from the past month.

GPs continue to prescribe outdated antibiotics for gonorrhoea


GPs continue to prescribe outdated antibiotics for gonorrhoea

GPs are continuing to prescribe outdated antibiotics for the treatment of gonorrhoea, according to research reported in BMJ Open.

Analysis of electronic health records reveals that ciprofloxacin accounted for 42% of GP prescriptions for gonorrhoea in 2006 and 20% in 2011, despite 2005 treatment guidelines stating that ciprofloxacin should not be used.

“Practitioners should be alert to revisions to national treatment guidelines,” write the authors.

Using data from two large databases, the researchers uncovered approximately 1.4 million chlamydia and 233,000 gonorrhoea diagnoses between 2000 and 2011. The proportion of patients with chlamydia who were treated by community and specialist STI services doubled over the study period, whereas for gonorrhoea the proportion of diagnoses made by GPs versus STI clinics fluctuated.

More than 90% of patients overall were prescribed a recommended antimicrobial. Among patients with chlamydia, the proportion of non-recommended regimens fell from 7.0% in 2000 to 1.5% in 2011. For gonorrhoea, ciprofloxacin was the most commonly prescribed antibiotic.

ICS have neutral effect on mortality in COPD despite pneumonia risk


ICS have neutral effect on mortality in COPD despite pneumonia risk

Use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) is associated with an increased risk of pneumonia but a neutral or even reduced risk of mortality, suggest data presented at the 2015 American Thoracic Society International Conference.

“Although ICS might predispose COPD patients to the increased risk of pneumonia, their anti-inflammatory and/or other mitigating effects might paradoxically counterbalance this risk,” says lead author Ena Gupta, from University of Florida college of medicine. Gupta’s group analysed 38 studies of patients with COPD. The unadjusted risk of pneumonia was increased in patients using ICS, with relative risks (RR) ranging from 1.61 in randomised controlled trials (95% confidence interval [CI] 1.35–1.93) to 1.89 in observational studies (95% CI 1.39–2.59). By contrast, overall and pneumonia-associated mortality were apparently unaffected or reduced by ICS use: RRs ranged from 0.79 (95% CI 0.65–0.97) to 0.95 (95% CI 0.85–1.05) for overall mortality and from 0.72 (95% CI 0.59–0.88) to 0.91 (95% CI 0.52–1.59) for pneumonia-associated mortality.

Royal colleges launch campaign to reduce unnecessary interventions

A campaign to encourage doctors to stop using interventions that are not supported by clinical evidence has been launched by the Academy of Medical Royal Colleges (AMRC).

Each of the colleges is surveying its members and will produce its own list of five interventions that are commonly used but have no proven benefit. The AMRC hopes the initiative will trigger an end to the “over diagnosis and over treatment” culture in the NHS and replace it with one based on the belief that doing nothing can be the best option. The Choosing Wisely campaign is based on a US and Canadian model.

Lumacaftor-ivacaftor improves lung function in cystic fibrosis

Combination therapy with two drugs that target the most common genetic cause of cystic fibrosis (CF) has been found to improve lung function and reduce the rate of pulmonary exacerbations in patients with the disease, in a study published in The New England Journal of Medicine on 17 May 2015. Researchers tested a combination of lumacaftor and ivacaftor in 1,108 CF patients whose disease was caused by the Phe508del CFTR gene mutation, responsible for around 45% of cases. The combination is a “major advance” in the treatment and quality of life of people with CF, says lead researcher Stuart Elborn from Queens University Belfast.

FDA approves two new drugs for irritable bowel syndrome

Source: Wikimedia Commons

FDA approves two new drugs for irritable bowel syndrome

The US Food and Drug Administration (FDA) has approved two new treatments for patients with irritable bowel syndrome with diarrhoea (IBS-D).

Rifaximin (marketed as Xifaxan by Salix Pharmaceuticals) is an antibiotic, and eluxadoline (marketed as Viberzi by Actavis) is an antagonist and agonist of the δ and µ opioid receptors, respectively. Eluxadoline has been approved as a first-line treatment for the condition and is described by Actavis as a first-in-class drug. Rifaximin is already available as an antibiotic in Europe for other conditions.

Anton Emmanuel, a gastroenterologist at University College Hospital in London, says rifaximin treatment for IBS-D is based on the theory that some people with the condition have an imbalance of bacteria in the gut. “This is a controversial theory,” he says. Some researchers in the United States believe that all patients with IBS have this imbalance. “In the UK and Sweden we’ve found it to be closer to around 15–20% of patients,” says Emmanuel.

Newer contraceptive pills associated with higher risk of clots


Newer contraceptive pills associated with higher risk of clots

Combined contraceptive pills containing one of the newer progestogens are associated with a higher risk of venous thromboembolism (VTE) than pills containing older progestogens, a study published in The BMJ has found.

The increased clot risk associated with combined oral contraceptives is well known, but the relative risks associated with different hormone combinations have been unclear.

Using UK prescription data, researchers identified 10,562 eligible VTE cases and 42,034 matched controls.

Current users of any combined oral contraceptive had a threefold increased risk of VTE compared with non-users of similar age and health status (adjusted odds ratio 2.97, 95% confidence interval 2.78–3.17).

Women using combined pills containing older progestogens (levonorgestrel, norethisterone and norgestimate) had around a two and a half times increased risk of VTE compared with women not using any form of pill, while women using pills containing newer progestogens (drospirenone, desogestrel, gestodene and cyproterone) had around a four times increased risk of VTE.

PCSK9 inhibitor evolocumab gets green light for European approval

Evolocumab (Repatha), the first biologic drug for the treatment of hypercholesterolaemia, is set to launch following a positive opinion from the European Medicines Agency (EMA).

It is the first monoclonal antibody for treating high cholesterol and the first inhibitor of proprotein convertase subtilisin/kexin type 9 (PCSK9) to be recommended for approval.

Evolocumab, recommended at the May 2015 meeting of the EMA’s Committee for Medicinal Products for Human Use (CHMP), provides a new option for people who are unable to control their cholesterol levels with current treatments such as statins and other lipid-lowering drugs. It is also an alternative therapy for people who are statin-intolerant.

Proton pump inhibitors are associated with increased risk of heart attack

People who take proton pump inhibitors (PPIs) have a greater risk of suffering a heart attack, suggests a data-mining study published in PLOS ONE on 10 June 2015.

Researchers assessed data from 16 million clinical documents relating to 2.9 million individuals for pharmacovigilance information.

Patients with gastro-oesophageal reflux disease who took PPIs, whose main action is to reduce the production of gastric acid, were more likely than the general population to suffer a heart attack (adjusted odds ratio 1.16; 95% confidence interval 1.09–1.24), while alternative heartburn therapies, H2 blockers, were not associated with an increased risk.

EMA to review diabetes drugs after cases of ketoacidosis


EMA to review diabetes drugs after cases of ketoacidosis

A spate of cases of acidosis that sparked a warning in the United States has prompted the European Medicines Agency (EMA) to review incidences of potentially life-threatening ketoacidosis linked to drugs used to treat type 2 diabetes.

The EMA is looking for any reported cases of the condition in patients using sodium-glucose co-transporter-2 (SGLT2) inhibitors.

The review will focus on dapagliflozin (Forxiga), canagliflozin (Invokana), empagliflozin (Jardiance), canagliflozin/metformin (Vokanamet) and dapagliflozin/metformin (Xigduo).

Diabetic ketoacidosis (DKA), which occurs when the body produces high levels of blood acids or ketones, usually develops when insulin levels are too low or during prolonged fasting. The cases reported to the US Food and Drug Administration (FDA) were not typical DKA because blood sugar levels in the patients were only slightly increased compared to typical DKA.

Symptoms include breathing difficulty, nausea, vomiting, abdominal pain, confusion and unusual fatigue.

The FDA recorded 20 cases of acidosis reported as diabetic ketoacidosis, ketoacidosis or ketosis in patients treated with the drugs between March 2013 and June 2014.

Hospital hires pharmacists for wards amid nurse shortage


Hospital hires pharmacists for wards amid nurse shortage

Newly qualified pharmacists are being drafted into inpatient wards at a hospital in the east of England, after it struggled to recruit enough nurses. Chiefs at Colchester University Hospital NHS Foundation Trust gave the green light to employ foundation-level pharmacists in band 6 positions across four pilot wards covering medical, surgical, orthopaedic and elderly care.

The pharmacists will undertake medicines management tasks, such as supply and optimisation, alongside typical nursing responsibilities including IV cannulation, drug rounds and discharge planning, and will have to complete a competency programme. Chief pharmacist Richard Needle says the roles are a huge opportunity for junior pharmacists. The foundation trust has faced an “all-time high” of nursing vacancy rates, but in contrast, it received a large number of applications for a band 6 pharmacist post. Under the initiative, approved by trust executives on 1 May 2015, funding for unfilled nursing roles will be used to hire up to 12 pharmacists for two-year internships.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2015.20068772

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Supplementary images

  • US FDA building
  • ICS have neutral effect on mortality in COPD despite pneumonia risk
  • FDA approves two new drugs for irritable bowel syndrome
  • Newer contraceptive pills associated with higher risk of clots
  • EMA to review diabetes drugs after cases of ketoacidosis
  • Hospital hires pharmacists for wards amid nurse shortage

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