Measles still menacing

An epidemiological study of measles in Europe has revealed a worrying trend: suboptimal vaccination coverage has resulted in over 12 000 cases in 2 years, and a fifth of these were in people aged 20 years or older. Five countries in particular recorded high numbers of cases and outbreaks — Romania, Germany, UK, Switzerland and Italy. The majority of cases occurred in unvaccinated or incompletely vaccinated children. Seven deaths occurred over the 2 years of the study. The authors comment that the data indicate the current European goal of measles eradication by 2010 may not be feasible with the current suboptimal rate of vaccination coverage.

Lancet Online; 7 Jan 2009

Wound infection

A single application of topical chloramphenicol (Chloromycetin ointment) to high-risk sutured wounds appears to reduce the infection rate, but the clinical significance of the findings is uncertain, according to the results of an Australian study. In the randomised controlled trial involving over 900 minor surgery patients, half received topical chloramphenicol and half placebo after minor skin excisions. The infection rate in the chloramphenicol group (6.6%) was significantly lower than that in the control group (11.0%), a relative reduction of 40%. The absolute reduction of 4.4%, however, fell just beneath the pre-determined reduction for clinical relevance (5%). The authors comment that the rate of infection in their North Queensland-based group was higher than that in the published literature, and acknowledged the study had limitations, but concluded that the application of a single dose of topical chloramphenicol in this setting resulted in a moderate absolute reduction in infection rate.

BMJ 2009; 338: a2812

Fibromyalgia treatment

The chronic pain disorder, fibromyalgia syndrome (FMS), is associated with numerous somatic and psychological symptoms and a reduced health-related quality of life. Promisingly, the use of antidepressants in FMS appears to be advantageous, according to the results of a meta-analysis conducted by German researchers. Eighteen randomised controlled trials studying the effects of different classes of antidepressants on 1427 participants with FMS were included in the analysis. Reductions in pain, depressed mood and sleep disturbance were noted, along with improved health-related quality of life. The effect size on pain reduction was greater with tricyclic antidepressants. The authors comment that longer-term studies are needed to analyse the effects of antidepressant therapy on FMS, and to clarify the cost-effectiveness of treatment.

JAMA 2009; 301: 198-209

Kids with asthma

High-dose inhaled corticosteroids (ICS) may have been overprescribed for children with asthma in the past, according to UK researchers. A retrospective, cross-sectional observational study was conducted over 14 years and used data on hundreds of thousands of children. With the premise that high-dose ICS are overprescribed in asthmatic children, researchers collected general practitioner prescribing information. An increase in all inhaled asthma treatment use was observed over the early 1990s, with a peak in 1997, which fell thereafter. In contrast, use of unlicensed very-high-dose ICS (> 800 mg/day) in older asthmatic children increased progressively in the same time period. The authors suggest the changes may be due to adherence to introduced guidelines, changes in asthma incidence, and the decreasing use of sodium chromoglicate. They comment that the prescription of very-high-dose ICS in older children requires further investigation.

Arch Dis Child 2009; 94: 16-22.

Dr Tanya Grassi, MJA

©The Medical Journal of Australia 2009 www.mja.com.au PRINT ISSN: 0025-729X ONLINE ISSN: 1326-5377