"8 drugs doctors wouldn't take"
With 3,480 pages of fine print, the Physicians' Desk Reference (a.k.a. PDR) is not a quick read. That's because it contains every iota of information on more than 4,000 prescription medications. Heck, the PDR is medication — a humongous sleeping pill.
Doctors count on this compendium to help them make smart prescribing decisions — in other words, to choose drugs that will solve their patients' medical problems without creating new ones. Unfortunately, it seems some doctors rarely pull the PDR off the shelf. Or if they do crack it open, they don't stay versed on emerging research that may suddenly make a once-trusted treatment one to avoid. Worst case: You swallow something that has no business being inside your body.
Of course, plenty of M.D.'s do know which prescription and over-the-counter drugs are duds, dangers, or both. So we asked them, "Which medications would you skip?" Their list is your second opinion. If you're on any of these meds, talk to your doctor. Maybe he or she will finally open that big red book with all the dust on it.
Advair
It's asthma medicine ... that could make your asthma deadly. Advair contains the long-acting beta-agonist (LABA) salmeterol. A 2006 analysis of 19 trials, published in the Annals of Internal Medicine, found that regular use of LABAs can increase the severity of an asthma attack. Because salmeterol is more widely prescribed than other LABAs, the danger is greater — the researchers estimate that salmeterol may contribute to as many as 5,000 asthma-related deaths in the United States each year. In 2006, similarly disturbing findings from an earlier salmeterol study prompted the FDA to tag Advair with a "black box" warning — the agency's highest caution level.
Your new strategy: No matter what you may have heard, a LABA, such as the one in Advair, is not the only option, says Philip Rodgers, Pharm.D., a clinical associate professor at the University of North Carolina school of pharmacy. For instance, if you have mild asthma, an inhaled corticosteroid such as Flovent is often all you need. Still wheezing? "Patients can also consider an inhaled corticosteroid paired with a leukotriene modifier," says Dr. Rodgers. This combo won't create dangerous inflammation, and according to a Scottish review, it's as effective as a corticosteroid-and-LABA combo.
Avandia
Diabetes is destructive enough on its own, but if you try to control it with rosiglitazone — better known by the brand name Avandia — you could be headed for a heart attack. Last September, a Journal of the American Medical Association (JAMA) study found that people who took rosiglitazone for at least a year increased their risk of heart failure or a heart attack by 109 percent and 42 percent, respectively, compared with those who took other oral diabetes medications or a placebo.
The reason? While there have been some reports that Avandia use may cause dangerous fluid retention or raise artery-clogging LDL cholesterol, no one is sure if these are the culprits. That's because the results of similar large studies have been mixed. So the FDA has asked GlaxoSmithKline, the maker of Avandia, to conduct a new long-term study assessing users' heart risks. There's only one problem: The study isn't expected to start until later this year.
Your new strategy: Stick with a proven performer. "I prefer metformin, an older, cheaper, more dependable medication," says Sonal Singh, M.D., the lead author of the JAMA study. "Avandia is now a last resort." Dr. Singh recommends that you talk to your doctor about cholesterol-lowering medicines, such as statins or the B vitamin niacin. Swallowing high doses (1,000 milligrams) of niacin daily may raise your HDL (good) cholesterol by as much as 24 percent, while at the same time lowering your LDL and triglyceride levels.
Celebrex
Once nicknamed "super aspirin," Celebrex is now better known for its side effects than for its pain-relieving prowess. The drug has been linked to increased risks of stomach bleeding, kidney trouble, and liver damage. But according to a 2005 New England Journal of Medicine study, the biggest threat is to your heart: People taking 200 mg of Celebrex twice a day more than doubled their risk of dying of cardiovascular disease. Those on 400 mg twice a day more than tripled their risk, compared with people taking a placebo.
And yet Celebrex, a COX-2 inhibitor, is still available, even though two other drugs of that class, Bextra and Vioxx, were pulled off the market due to a similar risk of heart damage. The caveat to the consumer? In 2004, the FDA advised doctors to consider alternatives to Celebrex.
Your new strategy: What you don't want to do is stop swallowing Celebrex and begin knocking back ibuprofen, because regular use of high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to gastrointestinal bleeding. A safer swap is acupuncture. A German study found that for people suffering from chronic lower-back pain, twice-weekly acupuncture sessions were twice as effective as conventional treatments with drugs, physical therapy, and exercise. The strategic needling may stimulate central-nervous-system pathways to release the body's own painkillers, including endorphins and enkephalins, says Duke University anesthesiologist Tong-Joo Gan, M.D. You can find a certified acupuncturist in your area at
Ketek
Most bacteria in the lungs and sinuses don't stand a chance against Ketek, but you might not either. This antibiotic, which has traditionally been prescribed for respiratory-tract infections, carries a higher risk of severe liver side effects than similar antibiotics do. "Ketek can cause heart-rhythm problems, can lead to liver disease, and could interact poorly with other medications you may be taking," says Dr. Rodgers. "Unfortunately, it's still available, and although many doctors are aware of the risks, some may still prescribe it without caution." In February 2007, the FDA limited the usage of Ketek to the treatment of pneumonia.
Your new strategy: Can't imagine catching pneumonia? The last time the Centers for Disease Control and Prevention calculated the top 10 killers of men, this deadly lung infection (along with the flu) came in seventh. Avoid backing yourself into a corner where you might need Ketek by always signing up for your annual flu shot — if you have pneumonia, it'll reduce your risk of dying of the infection by 40 percent. And if you still end up staring at a scrip for Ketek, Dr. Rodgers recommends asking to be treated with one of several safer alternatives, such as Augmentin or the antibiotics doxycycline or Zithromax.
Prilosec and Nexium
Heartburn can be uncomfortable, but heart attacks can be fatal, which is why the FDA has investigated a suspected link between cardiac trouble and the acid-reflux remedies Prilosec and Nexium. In December 2007, the agency concluded that there was no "likely" connection. Translation: The scientific jury is still out. In the meantime, there are other reasons to be concerned. Because Prilosec and Nexium are proton-pump inhibitors, they are both incredibly effective at stopping acid production in the stomach — perhaps too effective.
A lack of acid may raise your risk of pneumonia, because the same stuff that makes your chest feel as if it's burning also kills incoming bacteria and viruses. You may also have an elevated risk of bone loss — in the less acidic environment, certain forms of calcium may not be absorbed effectively during digestion. "The risk of a fracture has been estimated to be over 40 percent higher in patients who use these drugs long-term, and the risk clearly increases with duration of therapy," says Dr. Rodgers.
Your new strategy: When you feel the fire, first try to extinguish it with Zantac 150 or Pepcid AC. Both of these OTC products work by blocking histamine from stimulating the stomach cells that produce acid. Just know that neither drug is a long-term fix.
"To really cure the problem, lose weight," says Michael Roizen, M.D., chief wellness officer at the Cleveland Clinic and co-author of "YOU: The Owner's Manual." That's because when you're overweight, excess belly fat puts pressure on and changes the angle of your esophagus, pulling open the valve that's supposed to prevent stomach-acid leaks. This in turn makes it easier for that burning sensation to travel up into your chest.
Visine Original
What possible harm to your peepers could come from these seemingly innocuous eyedrops? "Visine gets the red out, but it does so by shrinking blood vessels, just like Afrin shrinks the vessels in your nose," says Thomas Steinemann, M.D., a spokesman for the American Academy of Ophthalmology. Overuse of the active ingredient tetrahydrozoline can perpetuate the vessel dilating-and-constricting cycle and may cause even more redness.
Your new strategy: If you still want to rely on Visine, at least make sure you don't use too many drops per dose and you don't use the stuff for more than 3 or 4 days. But you'd really be better off figuring out the underlying cause of the redness and treating that instead. If it's dryness, use preservative-free artificial tears, recommends Dr. Steinemann. Visine Pure Tears Portables is a good choice for moisture minus side effects. On the other hand, if your eyes are itchy and red because of allergies, pick up OTC antiallergy drops, such as Zaditor. It contains an antihistamine to interrupt the allergic response but no vasoconstrictor to cause rebound redness.
Pseudoephedrine
Forget that this decongestant can be turned into methamphetamine. People with heart disease or hypertension should watch out for any legitimate drug that contains pseudoephedrine. See, pseudoephedrine doesn't just constrict the blood vessels in your nose and sinuses; it can also raise blood pressure and heart rate, setting the stage for vascular catastrophe. Over the years, pseudoephedrine has been linked to heart attacks and strokes. "Pseudoephedrine can also worsen symptoms of benign prostate disease and glaucoma," says Dr. Rodgers.
Your new strategy: Other OTC oral nasal decongestants can contain phenylephrine, which has a safety profile similar to pseudoephedrine's. A 2007 review didn't find enough evidence that phenylephrine was effective. Our advice: Avoid meds altogether and clear your nasal passages with a neti pot, the strangely named system that allows you to flush your sinuses with saline ($15, sinucleanse.com). University of Wisconsin researchers found that people who used a neti pot felt their congestion and head pain improve by as much as 57 percent. Granted, the flushing sensation is odd at first, but give it a chance. Dr. Roizen did: "I do it every day after I brush my teeth," he says.
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ATLANTA, Oct. 16 — Nearly 19,000 people died in the United States in 2005 after being infected with virulent drug-resistant bacteria that have spread rampantly through hospitals and nursing homes, according to the most thorough study of the disease’s prevalence ever conducted.
The government study, which is being published Wednesday in The Journal of the American Medical Association, suggests that such infections may be twice as common as previously thought, according to its lead author, Dr. R. Monina Klevens.
If the mortality estimates are correct, the number of deaths associated with the germ, methicillin-resistant Staphylococcus aureus, or MRSA, would exceed those attributed to H.I.V.-AIDS, Parkinson’s disease, emphysema or homicide each year.
By extrapolating data collected in nine places, the researchers estimated that 94,360 patients developed an invasive infection from the pathogen in 2005 and that nearly one of every five, or 18,650 of them, died. The study points out that it is not always possible to determine whether a death is caused by MRSA or merely accelerated by it.
The authors, who work for the Centers for Disease Control and Prevention, cautioned that their methodology differed significantly from previous studies and that direct comparisons were therefore risky. But they said they were surprised by the prevalence of serious infections, which they calculated as 32 cases per 100,000 people.
In an accompanying editorial in the medical journal, Dr. Elizabeth A. Bancroft, an epidemiologist with the Los Angeles County Department of Public Health, characterized that finding as “astounding.”
The prevalence of invasive MRSA — when the bacteria has not merely colonized on the skin, but has attacked a normally sterile part of the body, like the organs — is greater, Dr. Bancroft wrote, than the combined rates for other conditions caused by invasive bacteria, including bloodstream infections, meningitis and flesh-eating disease.
The study also concluded that 85 percent of invasive MRSA infections are associated with health care treatment. Previous research had indicated that many hospitals and long-term care centers had become breeding grounds for MRSA because bacteria could be transported from patient to patient by doctors, nurses and unsterilized equipment.
“This confirms in a very rigorous way that this is a huge health problem,” said Dr. John A. Jernigan, the deputy chief of prevention and response in the division of healthcare quality promotion at the disease control agency. “And it drives home that what we do in health care will have a lot to do with how we control it.”
The findings are likely to stimulate further an already active debate about whether hospitals and other medical centers should test all patients for MRSA upon admission. Some hospitals have had notable success in reducing their infection rates by isolating infected patients and then taking extra precautions, like requiring workers to wear gloves and gowns for every contact.
But other research has suggested that such techniques may be excessive, and may have the unintended consequence of diminishing medical care for quarantined patients. The disease control agency, in guidelines released last year, recommended that hospitals try to reduce infection rates by first improving hygiene and resort to screening high-risk patients only if other methods fail.
Dr. Lance R. Peterson, an epidemiologist with Evanston Northwestern Healthcare, said his hospital system in the Chicago area reduced its rate of invasive MRSA infections by 60 percent after it began screening all patients in 2005.
“This study puts more onus on organizations that don’t do active surveillance to demonstrate that they’re reducing their MRSA infections,” Dr. Peterson said. “Other things can work, but nothing else has been demonstrated to have this kind of impact. MRSA is theoretically a totally preventable disease.”
Numerous studies have shown that busy hospital workers disregard basic standards of hand-washing more than half the time. This week, Consumers Union, the nonprofit publisher of Consumer Reports, called for hospitals to begin publishing their compliance rates for hand-washing.
Lisa A. McGiffert, manager of the “Stop Hospital Infections” campaign at Consumers Union, said, “This study just accentuates that the hospital is ground zero, that this is where dangerous infections are occurring that are killing people every day.”
MRSA, which was first isolated in the United States in 1968, causes 10 percent to 20 percent of all infections acquired in health care settings, according to the disease control agency. Resistant to a number of front-line antibiotics, it can cause infections of surgical sites, the urinary tract, the bloodstream and lungs. Treatment often involves the intravenous delivery of other drugs, causing health officials to worry that overuse will breed further resistance.
The bacteria can be brought unknowingly into hospitals and nursing homes by patients who show no symptoms, and can be transmitted by contact as casual as the brush of a doctor’s lab coat. Highly opportunistic, they can enter the bloodstream through incisions and wounds and then quickly overwhelm a weakened immune system.
On Monday, a Virginia teenager died after a weeklong hospitalization for an MRSA infection that spread quickly to his kidneys, liver, lungs and the muscle around his heart. Local officials promptly closed 21 schools for a thorough cleaning.
A major difference between the new study and its predecessors is that it compiled confirmed cases of MRSA infection, rather than relying on coded patient records that sometimes lack precision. The study found higher prevalence rates and death rates for the elderly, African-Americans and men. The figures also varied by geography, with Baltimore’s incidence rates far exceeding those of the eight other locations: Connecticut; Atlanta; San Francisco; Denver; Portland, Ore.; Monroe County, N.Y.; Davidson County, Tenn.; and Ramsey County, Minn.
Dr. Klevens said further research would be needed to understand the racial and geographic disparities.
Originally posted at:
By THE ASSOCIATED PRESS RICHMOND, Va., Oct. 17 — A high school student hospitalized for more than a week with an antibiotic-resistant staph infection died on Monday, as schools across the country were reporting outbreaks of staph infections, including the antibiotic-resistant strain.
The student, Ashton Bonds, 17, was a senior at Staunton River High School in Moneta, Va., and Methicillin-resistant Staphylococcus aureus, or MRSA, was diagnosed in him, his mother said.
Officials shut down all 22 schools in Bedford County for cleaning today in an effort to keep the illness from spreading, after students at Staunton River organized a protest overnight Monday, using text messages and social networking sites. On Tuesday, the student organizers led the Bedford County schools superintendent, James Blevins, on a tour of the Staunton River school to show him the state of its sanitation, particularly in its locker rooms.
Mr. Blevins said at a news conference today that the high school would be cleaned today by a commercial cleaning company, and the county’s 21 other schools would be cleaned by their janitors.
Health and education officials have reported that staph infections, including the serious MRSA strain, have spread through schools nationwide in recent weeks.
MRSA is a strain of staph bacteria that does not respond to penicillin or related antibiotics, though it can be treated with other drugs. The infection can be spread by skin-to-skin contact or through sharing an item, like a towel or a piece of sports equipment, that has been used by an infected person, particularly one with an open wound.
The news of staff infections spreading through schools coincides with a report by doctors at the Centers for Disease Control and Prevention, which found that nearly 19,000 people had died in the United States in 2005 after an MRSA infection.
The study, which is being published today in The Journal of the American Medical Association, suggests that such infections may be twice as common as previously thought, according to its lead author, Dr. R. Monina Klevens.
If the mortality estimates are correct, the number of deaths associated with the MRSA germ would exceed those attributed to HIV-AIDS, Parkinson’s disease, emphysema or homicide each year.
In addition to the death of the Virginia high school student in Bedford County, The Roanoke Times reported today that at least 11 cases of MRSA infection have been reported in teenagers or children in southwest Virginia over the last six months.
In Newport News in the southeastern part of the state, a high school closed its weight room last Thursday after at least four students were infected; in at least one of the four cases, the staph germ is the MRSA strain, local school and health officials said. That patient, a football player, was hospitalized on Oct. 7 and released on Oct. 10.
No staph infection statistics are compiled by the Virginia Department of Education or the Virginia Health Department. But a spokesman for the state’s public school system, Charles Pyle, said the department would send information about prevention and treatment to all 132 school districts in Virginia for distribution to schools and parents.
Frequent and thorough washing of hands is one of the most important preventive measures, said Nicole Coffin, a spokeswoman for the Centers for Disease Control. Also, open wounds should be covered, and people should avoid sharing items like towels and razors.
Virginia is not the only state experiencing an outbreak of infections in schools. In neighboring Maryland, more than two dozen staph infections have been reported at four Anne Arundel County high schools since mid-September. School officials there said that crews have been scrubbing all 12 high schools in the county with a hospital-grade disinfectant, and that there was no cause for alarm.
In late September, five high school students in Waterloo, Ill., near St. Louis, were treated for apparent staph infections. The Waterloo school superintendent, James Helton, said it was the school district’s first problem with the bacterial infection, and that health officials had not identified its source. The high school was thoroughly cleaned after the students were treated.
In Ohio, staph infections have been reported recently in several school districts. The 800 students at Troy Christian Schools were sent home 90 minutes early on Oct. 9 as a precaution after at least one student contracted MRSA. The superintendent of schools, Gary Wilber, said classrooms, lockers, student belongings, school buses and other equipment were disinfected.
In September, a football player at Grove City High School near Columbus was hospitalized for six days with what started as a staph infection in his foot. The school’s locker room and training rooms were disinfected.
Health officials in North Carolina and Florida have also reported increases in staph infections.
“Most of what we hear about is athletic teams in school settings,” because there is often close contact among the players, said Zack Moore, epidemic intelligence service officer with the North Carolina Division of Public Heath.
Roger Sanderson, an epidemiologist with the Florida Department of Health in Tampa, agreed that sports teams seemed to be most at risk for staph problems.
“Nobody has reported any major outbreaks,” Mr. Sanderson said of the situation in Florida. “We do have schools that might have four or five cases, and we go in and give them basic infection control, like hand-washing, not sharing towels or razors, which football players do sometimes.”
The student who died in Virginia had gone to a hospital in Bedford on Oct. 4 after complaining of pain in his side, his mother said. He was sent home after doctors ruled out appendicitis, but was readmitted three days later and taken to a hospital in Roanoke.
Last week, doctors diagnosed an MRSA infection that had spread to his kidneys, liver, lungs and the muscles around his heart.
Early Thursday morning, the student had to be sedated and put on a ventilator. He was about to undergo surgery to drain fluid from his lungs when doctors detected a blood clot near his heart. His mother said the clot was inoperable.
Originally posted at:
By LINDSEY TANNER, CHICAGO (Oct. 17) - More than 90,000 Americans get potentially deadly infections each year from a drug-resistant staph "superbug," the government reported in its first overall estimate of invasive disease caused by the germ.
Deaths tied to these infections may exceed those caused by AIDS, said one public health expert commenting on the new study. Tuesdays report shows just how far one form of the staph germ has spread beyond its traditional hospital setting.
The overall incidence rate was about 32 invasive infections per 100,000 people. That's an "astounding" figure, said an editorial in Wednesday's Journal of the American Medical Association, which published the study.
Most drug-resistant staph cases are mild skin infections. But this study focused on invasive infections — those that enter the bloodstream or destroy flesh and can turn deadly.
Researchers found that only about one-quarter involved hospitalized patients. However, more than half were in the health care system — people who had recently had surgery or were on kidney dialysis, for example. Open wounds and exposure to medical equipment are major ways the bug spreads.
In recent years, the resistant germ has become more common in hospitals and it has been spreading through prisons, gyms and locker rooms, and in poor urban neighborhoods.
The new study offers the broadest look yet at the pervasiveness of the most severe infections caused by the bug, called methicillin-resistant Staphylococcus aureus, or MRSA. These bacteria can be carried by healthy people, living on their skin or in their noses.
An invasive form of the disease is being blamed for the death Monday of a 17-year-old Virginia high school senior. Doctors said the germ had spread to his kidneys, liver, lungs and muscles around his heart.
The researchers' estimates are extrapolated from 2005 surveillance data from nine mostly urban regions considered representative of the country. There were 5,287 invasive infections reported that year in people living in those regions, which would translate to an estimated 94,360 cases nationally, the researchers said.
Most cases were life-threatening bloodstream infections. However, about 10 percent involved so-called flesh-eating disease, according to the study led by researchers at the federal Centers for Disease Control and Prevention.
There were 988 reported deaths among infected people in the study, for a rate of 6.3 per 100,000. That would translate to 18,650 deaths annually, although the researchers don't know if MRSA was the cause in all cases.
If these deaths all were related to staph infections, the total would exceed other better-known causes of death including AIDS — which killed an estimated 17,011 Americans in 2005 — said Dr. Elizabeth Bancroft of the Los Angeles County Health Department, the editorial author.
The results underscore the need for better prevention measures. That includes curbing the overuse of antibiotics and improving hand-washing and other hygiene procedures among hospital workers, said the CDC's Dr. Scott Fridkin, a study co-author.
Some hospitals have drastically cut infections by first isolating new patients until they are screened for MRSA.
The bacteria don't respond to penicillin-related antibiotics once commonly used to treat them, partly because of overuse. They can be treated with other drugs but health officials worry that their overuse could cause the germ to become resistant to those, too.
A survey earlier this year suggested that MRSA infections, including noninvasive mild forms, affect 46 out of every 1,000 U.S. hospital and nursing home patients — or as many as 5 percent. These patients are vulnerable because of open wounds and invasive medical equipment that can help the germ spread.
Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University, said the JAMA study emphasizes the broad scope of the drug-resistant staph "epidemic," and highlights the need for a vaccine, which he called "the holy grail of staphylococcal research."
The regions studied were: the Atlanta metropolitan area; Baltimore, Connecticut; Davidson County, Tenn.; the Denver metropolitan area; Monroe County, NY; the Portland, Ore. metropolitan area; Ramsey County, Minn.; and the San Francisco metropolitan area.
Originally posted at:
www.awakenedhearts.com/healthissues.htm
maybe you should, too.
By Morgan Lord
updated 11:47 a.m. MT, Sun., June. 22, 2008
http://www.msnbc.msn.com/id/24777955/
medicalacupuncture.org/findadoc/index.html.
"Deadly Bacteria Found to Be More Common"
Published: October 17, 2007
http://topics.nytimes.com/top/reference/timestopics/organizations/c/centers_for_disease_control_and_prevention/index.html?inline=nyt-org
Below are additional articles on this subject.
Staph Infections Reported at Schools Across the Country
Published: October 17, 2007
http://www.nytimes.com/2007/10/17/us/17school-cnd.html?_r=1&oref=slogin
Staph Fatalities May Exceed AIDS Deaths
Posted: 2007-10-17 12:56:59
Filed Under: Health News, Nation News
http://news.yahoo.com/s/ap/20071017/ap_on_he_me/staph_infections
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