News Scan for May 09, 2017

Liberian meningitis serogroup
Overprescribing in the elderly

Liberian illness cluster blood samples yield serotype C meningitis

The US Centers for Disease Control and Prevention said yesterday that the positive test results for Neisseria meningitidis from four Liberian patients is serotype C, Science reported yesterday. Kai Kupferschmidt, the author of the Science report, said on Twitter today that the tests were on blood and that testing is under way on cerebrospinal fluid samples.

Health officials in Liberia told Science that improved public health training, sample collection, and testing in the wake of West Africa's Ebola outbreak streamlined the recognition and reporting of the unexplained illness outbreak that began in Sinoe County in people who attended the funeral of a religious leader.

Meningitis is now suspected as the cause of the outbreak, though health officials had been also exploring the possibility of point-source contamination of food or water.

According to the Science report, the number of serogroup C infections has been rising in Africa, with Nigeria and Niger fighting large outbreaks. Africa, home of the "meningitis belt" that includes parts of Nigeria and Niger but not Liberia, has made progress against the disease, but the vaccine used there covers only serogroup A.

Since the end of April, the Nigerian outbreak had led to 31 illnesses, 13 of them fatal.
May 8 Science report
Kai Kupferschmidt Twitter feed
May 8 CIDRAP News story "Meningitis suspected in Liberia's mystery illness outbreak"


Study: 46% of elderly patients got unnecessary antibiotics for URIs

A large new study out of Canada has found nearly half of elderly patients with nonbacterial acute upper respiratory infections (AURI) were prescribed antibiotics, despite guidelines that discourage the practice.

The study, published today in the Annals of Internal Medicine, was a retrospective analysis of patients 66 or older who presented with nonbacterial AURI from Jan 1 through Dec 31, 2012. While the primary outcome was the proportion of patients who received an antibiotic prescription within 30 days of their initial primary care visit, the investigators also analyzed characteristics of the patients and the primary care physicians who treated them. They used a multivariable logistics regression model to determine the relationship between those characteristics and antibiotic prescribing rates.

Overall, the investigators identified 185,014 patients aged 66 years or older who were managed by 8,990 unique physicians. The most commonly coded infections were the common cold (53.4%), acute bronchitis (31.1%), acute sinusitis (13.6%), and acute laryngitis (1.6%). Antibiotics were prescribed to 46.2% of patients, and patients who received an antibiotic were more likely than those who did not to have acute bronchitis (45.3% vs. 19.3%) or acute sinusitis (17.1% vs. 10.6%) and have received antibiotics in the previous year (34.2% vs. 27.7%).

The regression analysis showed that patients were more likely to receive antibiotics from mid- and late-career physicians (prescribing rates of 43.5% and 43%, respectively) than from early-career physicians (38.4%); from physicians trained internationally (45.2%) than from those trained in Canada and the United States (41.6%); and from physicians who saw 25-44 or more than 45 patients per day than those who saw fewer than 25 patients a day (43.3% and 44.4% vs. 40.3%). These results remained significant when only the common cold and laryngitis were examined.

The investigators also found that most prescriptions were for broad-spectrum agents, including macrolides, cephalosporins, and fluoroquinolones, despite the fact that broad-spectrum antibiotics are not recommended as initial therapy for any of the conditions studied.

"Our findings should be considered when planning interventions to reduce inappropriate prescribing," the authors of the study write. "Because clinical guidelines and other approaches to behavioral change do not appear to have had the desired effect on practice, further research on alternative strategies to deter inappropriate antibiotic prescribing is needed."
May 9 Ann Intern Med study

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