Clinical course of pharyngotonsillitis with group A streptococcus treated with different penicillin V strategies, divided in groups of Centor Score 3 and 4: a prospective study in primary care

Background

Sore throat is a common reason for prescribing antibiotics in primary care, and 10 days of treatment is recommended for patients with pharyngotonsillitis with group A streptococcus (GAS). Our group recently showed that penicillin V (PcV) four times daily for 5 days was non-inferior in clinical outcome to PcV three times daily for 10 days. This study compares duration, intensity of symptoms, and side effects in patients with a Centor Score (CS) of 3 or 4 respectively, after treatment with PcV for 5 or 10 days and evaluates whether all patients with pharyngotonsillitis with a CS of 3 or 4 should be treated for 5 days or if severity of symptoms or CS suggest a longer treatment period.

Method

Data on symptoms and recovery from patient diaries from 433 patients included in a RCT comparing PcV 800 mg × 4 for 5 days or PcV 1 g × 3 for 10 days was used. Patients six years and older with CS-3 or CS-4 and positive rapid antigen detection test for GAS-infection were grouped based on CS and randomized treatment. Comparisons for categorical variables were made with Pearson’s chi-squared test or Fisher’s exact test. Continuous variables were compared with the Mann–Whitney U test.

Results

Patients with CS-3 as well as patients with CS-4 who received PcV 800 mg × 4 for 5 days self-reported that they recovered earlier compared to patients with CS-3 or CS-4 who received treatment with PcV 1 g × 3 for 10 days. In addition, the throat pain as single symptom was relieved 1 day earlier in patients with CS-4 and 5 days of treatment compared to patients with CS-4 and 10 days of treatment. No differences in side effects between the groups were found.

Conclusion

Intense treatment with PcV four times a day for 5 days seems clinically beneficial and strengthens the suggestion that the 4-dose regimen with 800 mg PcV for 5 days may be the future treatment strategy for GAS positive pharyngotonsillitis irrespectively of CS-3 or CS-4.

Trail registration ClinicalTrials.gov ID: NCT02712307 (3 April 2016).

A scalable high-performance magnetic shield for very long baseline atom interferometry

We report on the design, construction, and characterization of a 10 m-long high-performance magnetic shield for very long baseline atom interferometry. We achieve residual fields below 4 nT and longitudinal inhomogeneities below 2.5 nT/m over 8 m along the longitudinal direction. Our modular design can be extended to longer baselines without compromising the shielding performance. Such a setup constrains biases associated with magnetic field gradients to the sub-pm/s² level in atomic matterwave accelerometry with rubidium atoms and paves the way toward tests of the universality of free fall with atomic test masses beyond the 10^-13 level.

Early ageing in middle-aged men is associated with adverse social factors and increased mortality risk: The Malmö Preventive Project

Aims: This study examined whether middle-aged men exhibiting markers of early ageing showed a different pattern of social factors, lifestyle, and biological variables compared with controls, and whether early ageing was associated with an increased mortality risk. Subjects and methods: We used a subgroup of 5,722 middle-aged men (mean age 47 years), investigated twice, from the Malmö Preventive Project (MPP), a screening programme attended by a total of 22,444 men between 1974 and 1992. Markers of biological ageing, such as decreased lung function, increased pulse pressure, and decreased height, were used to identify early aged subjects and a control group. These were followed up by use of local and national registers for a mean of 22 years. Cox's proportional regression was used to estimate multivariate relative risks (RR) for mortality with 95% confidence intervals (CI). Results: Men with early ageing were more often smokers, living alone, or less likely to be non-manual workers than control subjects. These men also had an increased age-adjusted mortality relative risk, RR 1.29 (95% CI 1.10—1.52). After adjustment for social and lifestyle factor there was still a significant difference in mortality between the two groups, RR 1.19 (95% CI 1.00—1.42). Conclusion: Early biological ageing in middle-aged men is associated with an increased mortality risk during long-term follow-up that cannot be fully explained by social background characteristics or adverse lifestyle.

Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records

OBJECTIVE

To study how prescription patterns concerning respiratory tract infections differ between interns, residents, younger general practitioners (GPs), older GPs and locums.

DESIGN

Retrospective study of structured data from electronic patient records.

SETTING

Data were obtained from 53 health centres and 3 out-of-hours units in Jönköping County, Sweden, through their common electronic medical record database.

PARTICIPANTS

All physicians working in primary care during the 2-year study period (1 November 2010 to 31 October 2012).

OUTCOME MEASURES

Physicians' adherence to current guidelines for respiratory tract infections regarding the use of antibiotics.

RESULTS

We found considerable differences in prescribing patterns between physician categories. The recommended antibiotic, phenoxymethylpenicillin, was more often prescribed by interns, residents and younger GPs, while older GPs and locums to a higher degree prescribed broad-spectrum antibiotics. The greatest differences were seen when the recommendation in guidelines was to refrain from antibiotics, as for acute bronchitis. Interns and residents most often followed guidelines, while compliance in descending order was: young GPs, older GPs and locums. We also noticed that male doctors were somewhat overall more restrictive with antibiotics than female doctors.

CONCLUSIONS

In general, primary care doctors followed national guidelines on choice of antibiotics when treating respiratory tract infections in children but to a lesser degree when treating adults. Refraining from antibiotics seems harder. Adherence to national guidelines could be improved, especially for acute bronchitis and pneumonia. This was especially true for older GPs and locums whose prescription patterns were distant from the prevailing guidelines.

Brachial plexus neuropathy following high-dose cytarabine in acute monoblastic leukemia

We describe brachial plexus neuropathy with high-dose cytarabine (Ara-C) therapy in a man who had acute monoblastic leukemia. Signs and symptoms of brachial plexus neuropathy appeared on two occasions within hours of exposure to high-dose Ara-C. Central nervous system complications have been described following systemic and intrathecal Ara-C. High-dose Ara-C has not been implicated previously as a cause of brachial plexus neuropathy.