Drug and Therapeutics Bulletin current issue

Prescribing in pregnancy--therapeutic discrimination?

2013-06-13T00:30:43-07:00

It is estimated that 10% of pregnant women have a chronic medical disorder that requires regular use of medicines. In addition, some women develop health problems during pregnancy, and at least 40% take a prescription drug at some point.1,2 The impact of the increasing age and body mass index of the population has contributed to the proportion of women who require medication during pregnancy. For example, 4% of women delivering in England and Wales in 2011 were aged 40 years or over (compared with 1% in the 1990s) and 19% of women of child-bearing age in England in 2008 were obese.3,4 The relative lack of information on the use of medicines during pregnancy remains an area of concern for healthcare professionals.

Indirect maternal deaths in the UK, where a new or pre-existing medical or mental health problem is aggravated...

DTB Select: 6 | June 2013

2013-06-13T00:30:43-07:00

Every month, DTB scans sources of information on treatments, disease management and other healthcare topics for key items to bring to our readers’ attention and help them keep up to date. To do this, we produce succinct, contextualised summaries of the information concerned. We also include comments on, for example, the strengths of the information, whether it contains anomalies, ambiguities, apparent error or omissions, or whether or how it affects current practice.

{blacktriangledown}Glycopyrronium for COPD

2013-06-13T00:30:43-07:00

Glycopyrronium powder for inhalation (Seebri Breezhaler—Novartis) is a long-acting muscarinic receptor antagonist (LAMA), licensed as a maintenance bronchodilator treatment to relieve symptoms in adults with chronic obstructive pulmonary disease (COPD).¹ This is the third long-acting agent that has recently been licensed in the UK for use in people with COPD (see Indacaterol for COPD² and Aclidinium for COPD?³). The company's promotional material claims that ‘Seebri is a once daily LAMA which supports cost effective prescribing at all stages of COPD’.⁴ In this article we review the evidence for glycopyrronium and assess its place in the management of COPD.

Prevention of recurrent urinary tract infections in women

2013-06-13T00:30:43-07:00

Around 40–50% of women experience at least one urinary tract infection (UTI) during their lifetime and 20–30% of these have a recurrence within 3–4 months of the initial infection.¹ Recurrent UTI (usually defined as three episodes in the last 12 months or two episodes in the last 6 months) can have a considerable impact on a woman's quality of life. Each episode of acute UTI in young women is typically associated with about 6 days of symptoms, 2.4 days of restricted activities and 0.4 days of bed rest.¹ Antibacterial prophylaxis is effective in preventing recurrent episodes, but at the expense of unwanted effects and a risk of promoting bacterial resistance. Here we assess the efficacy of different antibacterial regimens and non-antibacterial alternatives (cranberry, probiotics, oestrogens, immunostimulation, hyaluronic acid and chondroitin, acupuncture and herbs) in the prevention of recurrent uncomplicated UTIs in women.