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Antimicrobial stewardship: we know it works; time to make sure it is in place everywhere

Diamantis Plachouras, Susan Hopkins Antimicrobial stewardship: we know it works; time to make sure it is in place everywhere

Antimicrobial stewardship programmes were introduced in hospitals more than 30 years ago to address inappropriate antibiotic prescribing and increasing antibiotic resistance. Since then a large body of evidence on the effectiveness and safety of this approach has accumulated, and a new Cochrane Review updates the evidence on interventions and delivery methods to improve antibiotic prescribing.

The end of the wormwars?

David Tovey, Julia H Littell, Jeremy M Grimshaw The end of the wormwars?

The Cochrane Review of deworming populations in endemic areas, first published in 1998 and updated most recently in 2015 has attracted increasingly vociferous opposition to its findings. A new systematic review and network meta-analysis of deworming strategies by researchers working within the Campbell Collaboration supports the Cochrane Review findings. There is no dispute that treating children infected with worms is worthwhile, but the findings of the two systematic reviews together provide a strong case against the current population-wide programmes.

Preventing otitis media with pneumococcal conjugate vaccine: more data than certainty?

Chris Del Mar, Jane Smith Preventing otitis media with pneumococcal conjugate vaccine: more data than certainty?

Acute otitis media is one of the most common causes of children's visits to the doctor. It is also a common reason for prescribing antibiotics, so anything that prevents it has the extra bonus of contributing to reducing the worry of antibiotic resistance. A recently updated Cochrane Review summarises the complicated results of trials of pneumococcal vaccines with the outcome of preventing acute otitis media (rather than the original target of invasive pneumococcal disease). The data are complicated, but further trials are underway, so more information might be forthcoming to resolve what is currently confusing for clinicians.

Mosquito larval source management: evaluating evidence in the context of practice and policy

Robert D Newman, Abraham Mnzava, Zsofia Szilagyi Mosquito larval source management: evaluating evidence in the context of practice and policy

Authored by Tusting and colleagues, a new Cochrane review published in the August 2013 issue of the Cochrane Database of Systematic Reviews, looks at the effectiveness of larval source management for malaria control. The publication of this review is timely, but it is disappointing to learn that there continues to be a lack of robust evidence on the impact of larval source management on parasite prevalence and malaria incidence. Until there is more compelling evidence, larval control should continue to be viewed as a supplementary measure for malaria control in carefully selected settings. Promoting the widespread use of larval source management in rural areas of sub-Saharan Africa would be premature.

Cochrane Reviews on neglected diseases: the case of cutaneous leishmaniasis

Urbà González Cochrane Reviews on neglected diseases: the case of cutaneous leishmaniasis

The leishmaniases are a group of diseases caused by infection with protozoan parasites of the genus Leishmania. They affect the poorest of the poor and are associated with malnutrition, wars, displacement, poor housing, illiteracy, gender discrimination, lack of resources, and environmental changes. The infection is transmitted by bites from sandflies infected with the parasite. The World Health Organization (WHO) considers leishmaniasis to be one of the most serious parasitic diseases, and the World Health Assembly has advocated that authorities should address the major factors underlying the failure to control the disease.

Evidence supports TB test, so what now?

Danielle Cohen, Elizabeth Corbett Evidence supports TB test, so what now?

Accurate diagnosis of disease remains one of the biggest obstacles to global tuberculosis (TB) control. Inadequate diagnosis results in poor patient outcomes and contributes to sustained TB transmission. The majority of national TB control programmes, particularly in low- and middle-income countries, still rely predominantly on sputum microscopy for diagnosis. This is notoriously insensitive, particularly in HIV co-infected patients. Moreover, rapid and accurate diagnosis of drug resistance is required to control multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). An accurate, quick, and accessible test for the diagnosis of TB and determination of drug resistance is therefore a global priority.

Procalcitonin: hope in the fight against antibiotic resistance?

Chris Del Mar, Toby Lasserson Procalcitonin: hope in the fight against antibiotic resistance?

We normally think of calcitonin as a hormone produced by the C-cells of the thyroid, with the role of balancing parathyroid hormone in the conservation of calcium in the body. It's less widely known that calcitonin's precursor, procalcitonin, can be made by many cells, albeit at undetectable levels in healthy people. The discovery that procalcitonin is released into the blood in detectable amounts in response to severe bacterial infection was unexpected. It may be related to the finding that hypocalcaemia is often present in critically ill patients and correlates with severity of illness, although the relationship is complicated. Nevertheless, it opens a number of possibilities. Could procalcitonin be used as a diagnostic marker for serious infection? Any test or decision tool that helps to identify patients who do not need antibiotics could help to target antibiotic therapy more effectively.

Debating the evidence for deworming programmes

John Hilton, David Tovey Debating the evidence for deworming programmes

The July 2012 issue of The Cochrane Library included an update of a Cochrane Review on deworming drugs for soil-transmitted intestinal worms in children. The review hadn't been updated in four years and although a number of new trials had been found, the update didn't radically change the conclusions -- that there is a lack of high-quality evidence that community-based deworming programmes improve outcomes. The updated review also included summary of findings tables that presented the quality of evidence for each of the main outcomes using the GRADE methodology. Given the global investment in deworming programmes it’s not surprising that there was debate and differing opinion on the conduct of the review and its findings.

Neuraminidase inhibitors for influenza: methods change, principles don’t

Toby Lasserson, David Tovey Neuraminidase inhibitors for influenza: methods change, principles don’t

Systematic reviews seek to identify and summarise all the relevant research evidence relating to the clinical or health policy decision under consideration. This rationale can be fatally undermined if the review only includes a proportion of the research conducted, due to the restricted availability of some studies or their data. The recognition of reporting bias and its potential to confound the results of evidence synthesis is not new, and there is now ample methodological research demonstrating that studies with 'positive' results are more likely to be published and published sooner, than those with 'negative' results. If systematic reviews fail to address reporting biases they are at risk of generating misleading results. We should, therefore, pay particular attention to reviews that either identify strong evidence of a risk of reporting bias or adopt innovative methods to overcome it.

Assessing rapid diagnostic tests for malaria

Hasifa Bukirwa Assessing rapid diagnostic tests for malaria

Malaria remains a major cause of illness and death in Africa and other endemic, and often resource-limited, settings. Most cases of malaria are uncomplicated but can quickly turn into severe, often fatal, episodes in vulnerable individuals if not promptly diagnosed and effectively treated.

Evidence Aid and the disaster response in Pakistan and Haiti

Tracey P Koehlmoos Evidence Aid and the disaster response in Pakistan and Haiti

As if a natural disaster was not enough, Vibrio cholerae emerged to make the situation worse in post-flood Pakistan, and for the first time since the 1960s in post-earthquake Haiti. How do we, as researchers, policy-makers and human beings, respond to such situations? In response to the tsunami on 26 December 2004, concerned reviewers within The Cochrane Collaboration established Evidence Aid – an initiative that pools together systematic reviews that might be useful to disaster response agencies and decision-makers in crisis situations...

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