Prescrire international
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Prescrire international · Mar 2011
ReviewPreventing neonatal group B streptococcal infection. Intrapartum antibiotic prophylaxis in some high-risk situations.
Group B streptococci (GBS) are the leading cause of life-threatening neonatal bacterial infections in developed countries. The newborn is initially colonised during passage through the birth canal. Maternal vaginal carriage is usually asymptomatic. ⋯ In the United Kingdom, systematic antibiotic therapy is recommended in high-risk situations, without systematic screening for Group B streptococci. In practice, the first priority is to identify situations in which there is a high risk of neonatal GBS infection, and to administer antibiotics during labour, after screening for GBS carriage, if possible. Outside of these situations, the risk of an anaphylactic reaction must be minimised by choosing the prophylactic antibiotic based on maternal allergy history, and by avoiding antibiotic prophylaxis altogether if the mother has a history of anaphylaxis, whatever the cause.
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Prescrire international · Mar 2011
Imatinib and inoperable or metastatic gastrointestinal stromal tumours. Longer follow-up confirms the overall survival benefit.
In 2002, patients with inoperable or metastatic gastrointestinal stromal tumours had a median overall survival time of about 19 months with available treatment options. When it was first marketed in this setting in 2002, the efficacy of imatinib, a tyrosine kinase inhibitor, was mainly based on one trial evaluating a surrogate endpoint. This review examines new data, focusing on overall survival. ⋯ The frequency of serious adverse effects was significantly higher with a daily dose of 800 mg than with 400 mg. The mortality rate was higher with imatinib 800 mg/day. In practice, compared with cytotoxic chemotherapy, imatinib provides a tangible overall survival benefit in patients with inoperable or metastatic gastrointestinal stromal tumours, at a cost of varied, frequent and potentially life-threatening adverse effects.
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Prescrire international · Feb 2011
ReviewAdjuvant chemotherapy for localised colon cancer. Fluorouracil + folinic acid for node-positive, non-metastatic disease.
The standard treatment for colon cancer is surgical excision. Adjuvant chemotherapy is intended to reduce the risk of relapse, which is responsible for the death of nearly half of all patients treated surgically for localised disease. After surgery for stage III disease (node involvement without metastases), the 5-year survival rate is about 63% with adjuvant chemotherapy combining fluorouracil and folinic acid, versus 51% with placebo, a statistically significant difference. ⋯ No new drugs intended for the treatment of colon cancer have been introduced since 2006, but better evaluation of existing drugs means that patients with stage III colorectal cancer can now be offered a choice between standard intravenous fluorouracil and oral capecitabine or tegafur. Oxaliplatin adjunction is another option for patients under 65. The adverse effect profile is an important factor in the choice of treatment.