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Old September 24th, 2001, 21:26
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1999.08.23 Pearls

Treating childhood ear infections (otitis media) with antibiotics was no better than treating with placebo according to this meta-analysis. Of the 741 children under 2 years old studied, antibiotics were not superior to placebo in achieving clinical improvement at 1 week (95% odds ratio = 0.8 to 2.1). Damioseaux RAM. Br J Gen Pract 1998;48:1861.

This study from the University of Toronto and Harvard University estimated that the use of cellular phones while driving resulted in 1729 accidents, 317 injuries, and 2 deaths every single day in the United States. Redelmeier DA et al. Med Dec Making 1999;19:1.

Federal regulators last month called for a crackdown on internet pharmacies. Congress was urged to require disclosure rules to allow internet users to know the pharmacists and physicians involved in a website offering the online sale of medications. San Francisco Chronicle, July 31, 1999.

Low Vitamin D levels in the blood were found to be related to radiographic signs of osteoarthritis in this study of 237 elderly patients. The lead investigator recommends that everyone over age 65 take in at least 400 IU of vitamin D every day in the form of a multivitamin supplement. Lane NE et al. Arthritis Rheum 1999;42:854.

A single 2.5 mg dose of vitamin K was effective in treating excessive anticoagulation from coumadin therapy (INR's from 6 to 10). After an average 1.4 days, patients had normalized their INR and no bleeding episodes occurred in this study of 28 adults. Duong TM. Pharmacology 1998;18(6):1264.

This case report from Harvard University discusses how a woman died from the use of the herbs skullcap (skutellaria) and pau d'arco (tabebuia). The woman was self-treating herself for multiple sclerosis, and developed fatal hepatic failure. Although pure skullcap and pau d'arco do not contain the toxic pyrrolizidine alkaloids, these alkaloids are present in other herbs and may have been a contaminant in the woman's herbal preparations. This report notes that manufacturers of herbal preparations are not required to guarantee their products or provide documentation of safety and efficacy. Hullar TE et al. Am J Med 1999;106:267.

This study of 271 patients presenting to the emergency department with a simple laceration found that buffered lidocaine was not less painful than plain 1% lidocaine. Fatovich DM et al. J Emerg Med 1999;17(2):223.

For children with asthma, who are too young to use a metered dose inhaler, use of budesonide nebulizers was found to be effective. A dose of 0.5 mg twice daily or 1 mg once a day resulted in a significant reduction in asthma symptoms. Baker JW et al. Pediatrics 1999;103:414.

Many people use herbal skin creams because they believe them to be safer and free of steroids. This study analyzed the content of 11 chinese herbal skin creams recommended for eczema, scaling of the scalp, and eczema herpeticum. Of the 11 creams, 8 contained the steroid dexamethasone. The concentration of the steroid in the cream used for children was more than 5 times higher than is currently recommended for adults. The cream with the highest concentration of steroids was being used on a 4 month old child. The authors believe their findings are worrisome because the people using the creams were unaware of their steroid content. Use of steroids in these high doses, especially in infants, is associated with significant side effects. Keane FM et al. BMJ 1999;318:563.
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