Archive for May 2009

New acetaminophen dosing recommendations?

An FDA working group has recommended changes to acetaminophen dosing, to reduce the risk of accidental liver injury. Some of these include reducing the recommended maximum dose to 650mg, reducing the maximum daily dose to 3250mg (and lower for those who drink 3 or more alcoholic beverages a day), as well as eliminating the use of combination products. An FDA advisory committee is scheduled to meet in late June to review these changes, so stay tuned (FDA report).

Candidemia; epidemiology and mortality

In this large registry of >2000 patients with candidemia, about half were due to albicans, and half due to non-albicans species. Overall 12 week mortality was 35%, with the highest death in those with candida krusei (53%)and the lowest death in those with candida papapsilosis (24%). This helps us define prognosis in patients with candidemia (abstract).

Risk of death in afib ablation

In this international multi-center survey of ablation procedures for >32,000 patients with afib, the risk of death was 1/1000 (causes of death were tamponade, atria-esophageal fistula, stroke, and pneumonia). Given that this procedure is only indicated to improve quality of life, each patient will need to determine the risk-benefit ratio of this procedure, based on their severity of symptoms (abstract).

Compression stockings inadequate for DVT prophylaxis in CVA patients

In this large multi-center randomized controlled trial, over 2500 patients with acute stroke were randomized to thigh -high graduated compression stockings (GCS) or usual care. There was no significant difference in the risk of DVT (10% in GCS and 10.5% in usual care), but skin issues (breaks, ulcers, blisters, and necrosis) was much more common in the GCS group (5%) compared to usual care (1%). This study does not support the use of GCS in acute stroke patients, as there is no evidence of benefit, and some evidence of harm (abstract).

PPIs and risk of pneumonia

There is mounting evidence that PPI use is associated with higher risk for a number of infectious diseases (including clostridium difficile, SBP, and pneumonia). In this large prospective cohort, researchers examined the strength of association between PPIs and hospital acquired pneumonia (HAP), and found a 30% higher risk of HAP in those on PPIs than those not on PPIs (after multivariable adjustment). They did not find a significant association with H2 blockers (abstract). Over half of the inpatients received an acid suppressive medication during their inpatient stay. This study adds to the existing literature of the overuse and potential harm of acid suppressive medications in inpatients.