This week in the BMJ

Volume 326, Number 7399, Issue of 24 May 2003

Antibiotic combinations have no advantage in febrile neutropenia
Patients with stable asthma may be able to take less inhaled corticosteroid
Test and treat is the best empirical strategy for treating dyspepsia
Iron supplements benefit non-anaemic women with fatigue
Verbal autopsies give higher suicide rates in rural India
Diabetic patients' records are missing the C10 Read code

Antibiotic combinations have no advantage in febrile neutropenia

Combinations of ${beta}$ lactam with an aminoglycoside have no advantageover treatment with ${beta}$ lactam monotherapy for patients with feverand neutropenia. Paul and colleagues (p 1111) carried outa systematic review and meta-analysis of 47 studies, amountingto 7807 patients. Overall survival was no better with combinationtherapy than with monotherapy, and adverse effects were more common. Furthermore, broad spectrum monotherapy was a more successful treatment. The authors conclude that broad spectrum monotherapyoffers an overall benefit.

Patients with stable asthma may be able to take less inhaled corticosteroid

Stepping down the dose of inhaled corticosteroids in patientswith chronic stable asthma can reduce the amount taken withoutcompromising asthma control. Hawkins and colleagues (p 1115)conducted a one year, randomised, controlled, double blind trial among 259 primary care patients with asthma in westernand central Scotland. The participants were randomised to treatmentwith inhaled corticosteroids which either remained unchangedor were reduced by 50% by stepping down the dose. The groupshad similar rates of asthma exacerbation and similar numbersof visits to general practice or hospital, as well as similardisease specific and generic measures of health status.

OSCAR BURRIEL/SPL

Test and treat is the best empirical strategy for treating dyspepsia

A "test for Helicobacter pylori and treat" strategy is moreeffective than treatment with a proton pump inhibitor for managing dyspepsia in young patients. In a randomised controlled trialin patients aged under 45 with uninvestigated symptoms of dyspepsia,Manes and colleagues (p 1118) compared empirical treatmentwith omeprazole with test and treat (urea breath test for H pylori followed by eradication treatment if necessary or byomeprazole alone). With the test and treat strategy, symptomsresolved in many patients and the need for endoscopy was reduced,whereas symptoms usually recurred after a trial of omeprazole.The authors conclude that test and treat should be the preferredoption if empirical treatment of dyspepsia is to be performed.

Iron supplements benefit non-anaemic women with fatigue

Women with fatigue who are not anaemic may benefit from iron supplementation. Verdon and colleagues (p 1124) conducted adouble blind, randomised, placebo controlled trial in nineprimary care sites and among 144 women in western Switzerland.Fatigue after one month decreased by 30% in women taking iron,and by 13% in the placebo group. Subgroup analysis showed thatthe effect may be restricted to women with low or borderlineserum ferritin concentrations.

BSIP ZARAND/SPL

Verbal autopsies give higher suicide rates in rural India

Verbal autopsies—assessments of the cause of death withoutphysical examination—find suicide rates are double ortriple those found using other methods. Joseph and colleagues(p 1121) used data from verbal autopsies taken during 1994-9in a community health programme in rural southern India. Oldermen were more likely to commit suicide than younger men, andmost women who committed suicide were aged 15-24 or over 65.Verbal autopsies can give a good idea of suicide rates, whichare notoriously difficult to calculate accurately in developing countries because of census problems and because families areoften reluctant to reveal the cause of death in cases of suicide.

Diabetic patients' records are missing the C10 Read code

General practices need to use a wide range of codes to identifypeople with diabetes, as not all diabetic patients have theC10 Read code recorded in their computerised medical records.Gray and colleagues (p 1130) found that in one primary caregroup in south London only 63% of patients known to have diabetes were identified through the C10 Read code for diabetes.

SATURN STILLS/SPL

The rest were identified through prescription records and otherdiabetes related codes. The authors say that the use of Readcodes for diabetes needs to be standardised and coding levelsimproved if valid diabetes registers are to be constructedand the quality of care monitored effectively.