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zondag 12 maart 2017

DTB: Penicillin allergy--getting the label right

Penicillin allergy--getting the label right

Penicillini allergy is a potentially serious adverse reaction that impacts on antibacterial treatment options. Although it is commonly reported and recorded in medical records, only a minority of patients with a label of penicillin allergy actually have the condition confirmed. The term 'allergy' may be incorrectly applied to adverse reactions that do not have an immunological basis and inappropriate labelling of penicillin allergy can lead to the unnecessary avoidance of penicillins and other beta-lactam antibacterials. Here, we discuss key features that help to distinguish patients at low or high risk of having a true penicillin allergy, summarise what is known about the risk of allergic reactions to other beta-lactam antibacterials in patients with penicillin allergy and discuss the steps to consider when assessing a label of penicillin allergy.

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Desmopressin for nocturia in adults

Desmopressin has been used for many years in the treatment of diabetes insipidus, nocturnal enuresis (involuntary urination while asleep) and nocturia associated with multiple sclerosis (in adults aged up to 65 years); it has also been recommended in certain circumstances for the treatment of nocturia in men and women (previously, an unlicensed use).1,2 Recently, a new brand of desmopressin sublingual tablet (lyophilisate—an orally disintegrating tablet; Noqdirna–Ferring) has been licensed for use in adults of any age for the treatment of nocturia due to idiopathic nocturnal polyuria.3,4 The tablets contain a lower dose of desmopressin than was previously available. Unusually, there are different recommended doses for men and women. In this article, we consider the evidence on desmopressin in the treatment of idiopathic nocturnal polyuria in adults, and how this new formulation fits with current management strategies.

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DTB Select: 3 | March 2017

Potential for abuse and misuse of pregabalin and gabapentin | Risk of depression and suicidal thoughts with apremilast | Are patients overly optimistic about outcomes? | Pioglitazone and cardiovascular outcomes | Antipsychotics and risk of acute respiratory failure in patients with COPD | Improving adherence to lipid-lowering drugs | Canagliflozin associated with increased risk of amputation | Medical research news stories: how independent and qualified are commenters?

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Better PrEParation needed?

Last year, the Court of Appeal issued its ruling that NHS England has the authority to fund pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) – this was after the latter had declined to make PrEP available on the NHS, arguing that HIV prevention was the responsibility of local government.1,2

To many, this ruling will be seen as logical: PrEP, using a combination of emtricitabine and tenofovir (Truvada), is highly effective in preventing HIV infection, with clinical trials showing an 86% reduction in risk of acquiring HIV in men who have sex with men and a number-needed-to-treat between 13 and 18 to avoid one HIV infection over 1 year.3,4 In 2014, the Centers for Disease Control and Prevention in the USA recommended PrEP for those at high risk of acquiring HIV,5 with other countries such as Canada...

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