Prescrire international
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Prescrire international · Jun 2008
Papillomavirus vaccine types 16 and 18: new drug. Cervical cancer: just another vaccine.
The papillomavirus 16, 18 vaccine, like the papillomavirus 6, 11, 16, 18 vaccine, reduces the risk of high-grade cervical dysplasia due to all viral genotypes by about 40% in young women who are not yet infected at the time of vaccination. The vaccine does not seem to provoke any serious adverse effects, but there is no proof that it reduces the risk of cancer.
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Prescrire international · Jun 2008
Meningococcal B vaccine: new drug. The only vaccine against some serogroup B meningococci.
(1) Invasive infections due to serogroup B meningococci can be life-threatening. Antibiotics are not always effective. Vaccines available in France do not protect against serogroup B meningococci. (2) In the French region of Normandy, a vaccine manufactured by the Norwegian National Institute of Public Health and directed against serogroup B meningococci. (2) In the French region of Normandy, a vaccine manufactured by the Norwegian National Institute of Public Health and directed against a meningococcal strain related to the strain circulating in this region has been used since summer 2006 to protect children over one year of age and adolescents. (3) A review of the 16 available immunogenicity studies shows that immunogenicity is similar in children and adults when the vaccine is administered in two doses, six weeks apart. ⋯ The protection rate was 57% but the confidence interval was very wide (21% to 78%). A correlation was established between the bactericidal antibody titre and clinical protection. (5) In this trial, the adverse events studied in 877 adolescents were infrequent: less than 4% of local adverse events, and about the same proportion of systemic adverse events (headache, nausea, fatigue, malaise), led to taking time off school. (6) Too few data are available for infants. And it is difficult to extrapolate to other countries the results obtained in Norway 10 years ago with a vaccine that was manufactured differently and may be more immunogenic. (7) In practice, vaccination with the Norwegian vaccine is justified in areas where an epidemic strain closely related to the vaccine strain is circulating, even though only about 60% of vaccinees are protected after three doses.
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Prescrire international · Jun 2008
Dextropropoxyphene: welcome withdrawal from a French hospital's formulary.
Decision to exclude dextropropoxyphene from the list of drugs available at Toulouse University Hospital: more prescriptions of paracetamol as monotherapy and fewer prescriptions of step-2 analgesics.
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(1) Nicorandil is a vasodilator with limited efficacy, marketed for symptomatic relief of angina pectoris. Oral ulcerations, sometimes quite large, are an adverse effect of nicorandil that has been known since the 1990s. Cases of painful anal ulceration were reported later. (2) More recently, it has emerged that nicorandil can also cause very painful chronic ulceration of the colon and small intestine. ⋯ However, simply withdrawing nicorandil generally leads to recovery with a few weeks. (5) Nicorandil should not be considered a standard treatment for angina pectoris. It is better to choose another drug such as a betablocker. Nicorandil must be withdrawn if cutaneous or gastrointestinal ulceration occurs.