JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, July 10, 2007)
JAMA NEWS RELEASES
PROPHYLACTIC ANTIBIOTIC TREATMENT FOR CHILDREN WITH INITIAL URINARY TRACT INFECTION IS NOT ASSOCIATED WITH REDUCED RISK OF RECURRENCE
ANTI-MALARIAL DRUG MAY REDUCE RISK OF DIABETES FOR PATIENTS WITH RHEUMATOID ARTHRITIS
CLASS OF MEDICATIONS MAY OFFER ALTERNATIVE OPTION FOR TREATING TYPE 2 DIABETES
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
DAILY ANTIBIOTICS DO NOT PREVENT RECURRENT URINARY TRACT INFECTIONS IN CHILDREN — BUT DO INCREASE RISK OF ANTIBIOTIC-RESISTANT INFECTIONS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on the risk factors and treatments for recurrent urinary tract infections in children. The report will be fed Tuesday, July 10, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 09, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 10, 2007
Media Advisory: To contact Patrick H. Conway, M.D., M.Sc., call 617-680-8471.
PROPHYLACTIC ANTIBIOTIC TREATMENT FOR CHILDREN WITH INITIAL URINARY TRACT INFECTION IS NOT ASSOCIATED WITH REDUCED RISK OF RECURRENCE
CHICAGO—The use of prophylactic antibiotics, which involves daily administration of antibiotics to children after an initial urinary tract infection, is not associated with reduced risk of recurrent urinary tract infections, but is associated with an increased risk of resistant infections, according to a study in the July 11 issue of JAMA.
Estimates of cumulative incidence of UTI in children younger than 6 years (3 percent - 7 percent in girls, 1 percent - 2 percent in boys) suggest that 70,000 to 180,000 of the annual U.S. birth cohort will have experienced a UTI by age 6, according to background information in the article. Practice guidelines for after the first UTI in children recommend an imaging study to evaluate for the presence and degree (grade) of vesicoureteral reflux (VUR; a backflow of urine from the bladder into the ureter), a condition present in approximately 30 percent to 40 percent of children with UTI. If the child has VUR, daily antibiotic (destroying or suppressing the growth of microorganisms) treatment is recommended in an attempt to prevent recurrent UTIs. Evidence is limited regarding risk factors for recurrent urinary tract infection (UTI) and the risks and benefits of antibiotic treatment.
Patrick H. Conway, M.D., M.Sc., of the University of Pennsylvania Robert Wood Johnson Clinical Scholars Program, Philadelphia, and colleagues conducted a study to identify risk factors for recurrent UTI and estimate the effectiveness and possibility of resistance of antimicrobials in preventing recurrent UTI. Patients in the study were from a Children’s Hospital of Philadelphia supported network of 27 primary care pediatric practices in urban, suburban, and semi-rural areas spanning three states, with children ages birth through 6 years, who were diagnosed with first UTI between July 2001 and May 2006.
Among 74,974 children in the network, 611 had a first UTI and 83 had a recurrent UTI. The researchers found that factors associated with increased risk of recurrent UTI were white race (nearly twice the risk), age 3 to 4 years (2.75 times the risk), age 4 to 5 years (2.5 times the risk), and grade 4 to 5 VUR (4.4 times the risk). Severity of VUR is measured by a grade of 1-5, with 5 being the most severe. Sex, grade 1 to 3 VUR, and other antibiotic exposure had no effect on risk of recurrent UTI. Exposure to prophylactic antibiotics significantly increased the likelihood of resistant infections (7.5 times increased risk).
“Given ...previous findings and the unfavorable risk/benefit ratio demonstrated by the current study, we think it is prudent for clinicians to discuss the risks and unclear benefits of prophylaxis with families as they make family-centered decisions about whether to start prophylactic [antibiotics] or to closely monitor a child without prescribing [antibiotic] prophylaxis after a first UTI,” the authors write.
(JAMA. 2007;298(2):179-186. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 10, 2007
Media Advisory: To contact Mary Chester M. Wasko, M.D., M.Sc., call Michele Baum at 412-647-3555.
ANTI-MALARIAL DRUG MAY REDUCE RISK OF DIABETES FOR PATIENTS WITH RHEUMATOID ARTHRITIS
CHICAGO—Preliminary research suggests that use of the anti-malarial drug hydroxychloroquine may help reduce the risk of the development of diabetes in patients with rheumatoid arthritis, according to a study in the July 11 issue of JAMA.
Type 2 diabetes mellitus affects nearly 8 percent of US adults, and its prevalence has been increasing. Antimalarials such as hydroxychloroquine, a long-standing safe and inexpensive treatment for an autoimmune disease such as rheumatoid arthritis, theoretically may improve glucose tolerance and prevent diabetes mellitus, according to background information in the article. In vitro and animal studies indicate that antimalarials improve insulin secretion and peripheral insulin sensitivity.
Mary Chester M. Wasko, M.D., M.Sc., of the University of Pittsburgh, Pa., and colleagues examined the association between hydroxychloroquine therapy and risk of diabetes in patients with rheumatoid arthritis. The study included 4,905 adults with rheumatoid arthritis (1,808 had taken hydroxychloroquine and 3,097 had never taken hydroxychloroquine) with no initial diagnosis or treatment for diabetes, with 21.5 years of follow-up (Jan. 1983 through July 2004).
During the observation period, incident diagnoses of diabetes were reported by 54 patients who had taken hydroxychloroquine and by 171 patients who had never taken it. Analysis indicated that patients who had taken hydroxychloroquine had a 38 percent lower risk of developing diabetes, compared with those who had not taken hydroxychloroquine. This risk was further reduced with increased duration of hydroxychloroquine use. Patients who took hydroxychloroquine for more than four years had a 77 percent lower risk of diabetes compared with those who had never taken hydroxychloroquine.
“We report herein the first evidence, to our knowledge, suggesting that use of hydroxychloroquine is associated with a reduced risk of developing diabetes in patients with rheumatoid arthritis,” the authors write. “Moreover, risk reduction increased with duration of hydroxychloroquine exposure, supporting a biological action of this drug on glucose metabolism.”
“While our study showed a reduction in diabetes incidence specifically in a rheumatoid arthritis cohort taking hydroxychloroquine, these findings also may be expected to occur in patients without rheumatoid arthritis. The beneficial changes in glucose metabolism and insulin sensitivity reported among patients with lupus, patients with type 2 diabetes, and in animal models suggest that these effects are not specific to rheumatoid arthritis.”
“Antimalarial drugs may have a role in treating rheumatoid arthritis not only to suppress synovitis [inflammation around the joints] but also to reduce the likelihood of developing glucose intolerance and dyslipidemia [abnormal concentrations of lipids]. As quality of life and life expectancy improve for patients with rheumatoid arthritis, and health care costs escalate, the use of inexpensive, safe therapies that have multiple beneficial effects is attractive. Further prospective studies are needed to determine whether this treatment option should be considered a standard component of rheumatoid arthritis combination therapy in the future, and to evaluate the potential role of hydroxychloroquine as a preventive agent for diabetes among high-risk individuals in the general population,” the researchers conclude.
(JAMA. 2007;298(2):187-193. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, July 10, 2007
Media Advisory: To contact corresponding author Anastassios G. Pittas, M.D., M.Sc., call Melissa Sweeney at 617-636-3265.
CLASS OF MEDICATIONS MAY OFFER ALTERNATIVE OPTION FOR TREATING TYPE 2 DIABETES
CHICAGO—A review of previous studies indicates that use of a class of medications known as “incretin-based therapy”, which act via certain pathways that affect glucose metabolism may provide modest effectiveness and favorable weight change outcomes for the treatment of type 2 diabetes and may represent an alternative to other hypoglycemic therapies, according to an article in the July 11 issue of JAMA.
Current therapies for type 2 diabetes are often limited by adverse effects such as weight gain or hypoglycemia (low blood sugar). A more recent class of treatment to address these issues is incretin therapy, which involves glucose-stimulated insulin secretion by intestinally derived peptides, which are released in the presence of glucose or nutrients in the gut, according to background information in the article. In October 2006 the Food and Drug Administration approved the first oral incretin enhancer, sitagliptin, a selective DPP4 inhibitor (a class of oral hypoglycemics), for use as monotherapy or in combination with other medications. The effectiveness of this class of medications in managing type 2 diabetes is not well understood.
Renee E. Amori, M.D., of Tufts-New England Medical Center, Boston, and colleagues conducted a meta-analysis of 29 studies to assess the effectiveness and safety of incretin-based therapy (GLP-1 analogues and DPP4 inhibitors) in nonpregnant adults with type 2 diabetes.
“Our analysis of randomized controlled trials showed that incretin-based therapy with GLP-1 analogues or DPP4 inhibitors in adults with type 2 diabetes is moderately effective in improving glycemia, with greater reductions in postprandial [after a meal] glycemia and favorable (GLP-1 analogues) or neutral (DPP4 inhibitors) effects on weight. Glucagon [a hormone secreted by the pancreas]-like peptide 1 analogues were associated with gastrointestinal adverse effects, while DPP4 inhibitors had a slightly increased risk of infection (nasopharyngitis [inflammation of the nasal passages] and urinary tract infection) and headache,” the authors write.
“Incretin therapy offers an alternative option to currently available hypoglycemic agents for nonpregnant adults with type 2 diabetes with modest efficacy and a favorable weight change profile,” they write. “Individuals with mild diabetes, suggesting an adequate pancreatic beta cell reserve, who are at risk of hypoglycemic sequelae and in need of weight loss may benefit from this new class. However, these new classes of hypoglycemic agents will need continued evaluation both in long-term efficacy and safety controlled trials and in clinical practice to assess their effectiveness and safety profile to determine their role among the many available and well-established therapies for type 2 diabetes.”
(JAMA. 2007;298(2):194-206.. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
DAILY ANTIBIOTICS DO NOT PREVENT RECURRENT URINARY TRACT INFECTIONS IN CHILDREN – BUT DO INCREASE RISK OF ANTIBIOTIC-RESISTANT INFECTIONS
INTRO:
Pediatric experts recommend giving young children who get recurrent urinary tract infections, or U-T-I’s, daily antibiotics in hopes of preventing another U-T-I. But a new study of kids age six and younger says this recommendation may need to change. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
c/u of Lalani that matches her on mom’s lap
AUDIO:
LAILANI (lay-LAH-nee) HAS A URINARY TRACT INFECTION, AND IT’S NOT HER FIRST ONE.
VIDEO:
SOT/FULL
@ :08
Super: Virginia Summers
Lailani’s mom
Runs :08
AUDIO:
“I’m not very happy about it because she’s on lots of medications. She’s been on a lot of them since this has been going on and she’s only two years old, you know.”
VIDEO:
B-ROLL
Antibiotics – pharmacist pouring
GFX/JAMA COVER
AUDIO:
THOSE MEDICATIONS INCLUDE DAILY ANTIBIOTICS, WHICH ARE SUPPOSED TO PREVENT RECURRENT URINARY TRACT INFECTIONS. BUT A NEW STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, FOUND THAT:
VIDEO:
SOT/FULL
@ :27
Super: Patrick Conway, M.D., M.Sc.
University of Pennsylvania
Runs :09
AUDIO:
“Antibiotics did not prevent recurrent urinary tract infections and in fact, when children did get those infections they were more likely to be antibiotic resistant.”
VIDEO:
B-ROLL
Dr. Conway walking into office, sitting down at computer
Lalani close up of face
AUDIO:
DR. PATRICK CONWAY AND COLLEAGUES AT UNIVERSITY OF PENNSYLVANIA FOUND THAT TRUE EVEN FOR KIDS A YEAR LIKE LAILANI, WHO HAVE BLADDER REFLUX.
VIDEO:
SOT/FULL
Patrick Conway, M.D., M.Sc.
University of Pennsylvania
Runs :05
AUDIO:
“Bladder reflux is when urine comes up from the bladder towards the kidneys.”
VIDEO:
B-ROLL
Lailani in exam room on mom’s lap – doctor’s hand examining Lailani’s belly
AUDIO:
DOCTORS THOUGHT KIDS WITH BLADDER REFLUX WERE MORE LIKELY TO GET RECURRENT URINARY TRACT INFECTIONS, BUT...
VIDEO:
SOT/FULL
Patrick Conway, M.D., M.Sc.
University of Pennsylvania
Runs :06
AUDIO:
“The children with bladder reflux were not at increased risk of getting recurrent urinary tract infection.”
VIDEO:
B-ROLL
Pharmacist pouring antibiotics into cup, using syringe to extract medicine from cup
Pouring antibiotics into different bottle
AUDIO:
SO, THIS STUDY SHOWS THAT FOR KIDS WITH OR WITHOUT BLADDER REFLUX, ANTIBIOTICS ARE NOT HELPING PREVENT URINARY TRACT INFECTIONS, WHICH CAUSE PAIN DURING URINATION AND FEVER, AND MAY EVEN MAKE THE INFECTIONS HARDER TO TREAT DOWN THE ROAD.
VIDEO:
NAT SOT UP FULL FOR :10
Dr. Keren in exam room
AUDIO:
“The results are concerning and we want to obviously do the right thing and make sure we give kids medications that they need.”
VIDEO:
B-ROLL
Dr. Keren talking with Virginia
Looking at x-rays on light board
Lalani
Antibiotics
AUDIO:
DR. RON KEREN WAS AN AUTHOR ON THE STUDY, AND HAS TREATED MORE THAN A HUNDRED KIDS WITH URINARY TRACT INFECTIONS. HE SAYS PARENTS AND DOCTORS SHOULD CONSIDER WATCHING A CHILD FOR SYMPTOMS AND THEN GIVING ANTIBIOTICS TO TREAT INFECTION.
VIDEO:
SOT/FULL
Virginia Summers
Lalani’s mom
Runs :09
AUDIO:
“I’d be very happy to get her off the medications and rather wait for her to have something medically wrong with her'stead of treating her for something she doesn’t have at that point.”
VIDEO:
B-ROLL
Lailani close up
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
The researchers used electronic health records to identify more than six-hundred children with a first U-T-I, and then tracked those kids to see what treatment they received, and if they got recurrent infections, over the next thirteen months. For more information, visit www.jama.com.
