Thiazide Diuretics Could Reduce Osteoporosis Risk
By William T. Elliott, MD, FACP
Epidemiologic evidence has suggested that thiazide diuretics reduce the risk of osteoporosis and hip fracture. A new study substantiates this by showing that even low-dose hydrochlorothiazide can preserve bone mineral density in the hip and spine. More than 300 men and women were given hydrochlorothaizide 12.5 mg, 25 mg, or placebo for three years. Both treatment groups showed a reduced rate of bone loss compared to placebo, with a larger response seen in the 25-mg group. The effect was significant, although modest, but when extrapolated over years or decades of therapy for hypertension, it may be an important consideration for those at risk of osteoporosis (Ann Intern Med 2000;133:516-526).
"Resistant pneumococcus" has generally meant penicillin resistance until recently. Now multidrug resistant Streptococcus pneumoniae is turning up coast to coast. A recent survey of isolates from Atlanta, Ga., showed that up to a third of S. pneumoniae isolates were resistant to macrolide antibiotics including azithromycin and clarithromycin. The Emory University researchers report that the rate of macrolide resistance increased from 16% in 1994 to 32% in 1999, with many of the isolates from children. The implication is that macrolides may no longer be first-line therapy for invasive pneumococcal disease (J Infect Dis 2000;182:1417-1424).
Ginkgo biloba is not effective in older adults with mild to moderate dementia, according to a new study of 123 patients followed for 24 weeks. The double-blind placebo controlled trial used two doses of Ginko biloba and followed up with neuropsycological testing at 12 and 24 weeks. Neither dose produced any benefit on objective testing or self-perceived health or memory status (J Am Geriatr Soc 2000;48:1183-1194).
The theory that there may be a relationship between Chlamydia infections and coronary artery disease (CAD) was dealt a blow with the results of a recent University of Washington study. Researchers looked at more than 302 patients with CAD who were seropositive for Chlamydia pneumonia. Patients were randomized to receive either azithromycin 500 mg for three days, then 500 mg/wk for three months, or placebo. At six and 18 months, there was no significant difference in the rate of cardiovascular events between the two groups. The primary clinical end points included cardiovascular death, resuscitated cardiac arrest, nonfatal myocardial infarction, stroke, unstable angina, and unplanned coronary revascularization at two years (Circulation 2000;102:1755-1760).
Statins have been shown to improve bone density and reduce the risk of fractures in older women (Lancet 2000;255:2185-2188). Now research suggests the cholesterol-lowering medications may also reduce the risk of Alzheimer’s disease in older patients. Researchers from Illinois studied case records of more than 60,000 patients older than the age of 60. The expected rate of Alzheimer’s disease in patients taking either lovastatin or pravastatin was almost 70% lower than comparable patients who were not on the drugs. Interestingly, the same result was not seen with simvastatin, which did not show a protective effect. This study lends credence to the theory that cholesterol plays a role in the pathophysiology of Alzheimer’s disease (Arch Neurol 2000;57:1439-1443).
AstraZeneca’s omeprazole (Prilosec), the world’s best selling prescription medication, will not be available over the counter (OTC) in this country in the near future. The company recently petitioned the FDA to allow the switch to OTC, but two FDA advisory committees have recommended against the switch because of concerns over patients taking the drug inappropriately. They did, however, leave the door open for a later approval if the company improves the labeling for the OTC version of omeprazole. AstraZeneca may also need to provide the FDA with data on longer term use of the OTC strength of the drug, a common request when the first drug in a new prescription class goes OTC.
Phenylpropanolamine (PPA), a common decongestant found in many OTC and prescription cold and allergy medications may soon be classified as "unsafe" by the FDA. The FDA’s Non-Prescription Drug Advisory Committee recommended the change based on research from a large study from Yale university that suggests that PPA may increase the risk of hemorrhagic stroke. PPA is found in a number of popular OTC products including Alka-Seltzer Plus, Acutrim, Contac, Comtrex, Dexatrim, Dimetapp, Triaminic, and Robittussin CF. The risk of hemorrhagic stroke is particularly worrisome in young women who use the drug as a weight loss aide. The study was prompted by 18 case reports of hemorrhagic stroke, most of which occurred in otherwise healthy young women shortly after taking PPA. The FDA is yet to act on the committee’s recommendation.
A recent study from Chest confirms what most physicians already know: a history of penicillin allergy is usually not a contraindication for use of the drug. Twenty-one patients admitted to an ICU with history of penicillin allergy were administered penicillin skin tests. Twenty of the 21 patients tested negative, and 10 of them were administered penicillin, all without incident. The researchers suggest that skin testing is an effective way to test for penicillin allergy, and the drug can safely be administered to those who test negative (Chest 2000;118:1106-1108).
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