E-DRUG: UK Considers Antibiotics Study (3)
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Firstly my thanks to Wilbert Bannenberg for forwarding the original article.
It is well to note that the article was supported by an unrestricted
educational grant from Abbot Laboratories Ltd, the manufaturers of
macrolides (erythromycin and clarithromycin) and that the study was
conducted mostly over the latter half of the winter months.
My attempt in critting the article is by no means comprehensive. However the
following are of note: -
* The study cites a constant arbitrary value of 85% of the deaths in the
pneumonia mortality data collection being substracted from the "winter
excess" values. This weakens the study as the incidence of the LRTIs might
be related to the seasonal virulence of the influeza strain and other
factors e.g. the severity of the winter or the nutritional status of the
subjects.
It is well known that disease incidence cannot be presumed to be constant.
Extrapolations are possible but are used more as predictive tools rather
than for conclusive science.
* The winter analyses period for one living in the southern hemisphere is
confusing. Data collection for a 12 week period beginning in week 48 i.e.
beginning of December is questionable when the 21 st December is the
midpoint of the season. Would the results be significantly different if the
data was extracted for a 12 week period with the 21 December being the
midpoint of the data collection period? The extension of the phase as cited
in the study from 16 to 20 weeks equilaterally for unspecified factors
should cover the winter months comprehensively and would therefore be better
collected from the beginning of week 40?
* Missing in the data collection is the correct diagnosis and adherence to
the specified treatment guidelines. The impact of the correct treatment has
a large bearing on the results of such a study. The judicious use of an
antibiotic is significantly related to the correct diagnosis. It could
therefore be deemed to be negligent if an antibiotic was warranted and not
prescribed. The reverse is also very true.
A retrospective study based on pure science and not a predictive model, with
better defined study periods and inclusion of the correct diagnosis for each
case as a variable are all necessary to ascertain the correct links.
Therefore, for the mortality for CAP in the study, the potential links
cannot be proven to be related to antibiotic non-prescription when the other
important factors have not been included. A follow-up study with all
relevant details would be more meaningful.
Best wishes to all.
Mariam Cassimjee,
Co-ordinator of the KZN PTC
KZN Pharmaceutical Services
E-Wing, Addington Hospital
P/Bag X54318
Durban, 4000, South Africa.
Phone: +27-31-3327090
Fax: +27-31-3681093
Email:h994078@dohho.kzntl.gov.za
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