<html><body style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space; ">Queridos amigos:<div>En mi nuevo rol de asesor en ETS (Evaluación de nuevas Tecnologías Sanitarias) interesante bibliografía no habitual llega a mis manos.</div><div>Este artículo, que remite a una lectura del BJM es de sumo interés.</div><div>Para quiénes no lo sepan, les comento que NICE es la principal agencia asesora en ETS del UK.</div><div>Lo que está en negrita con mayor tamaño de letra, es mío</div><div><br></div><div>Un abrazo</div><div><br></div><div>Edgardo</div><div><br></div><div><a href="http://www.nice.org.uk/newsroom/news/AntibioticPrescribingCutByThreeQuarters.jsp">http://www.nice.org.uk/newsroom/news/AntibioticPrescribingCutByThreeQuarters.jsp</a></div><div><br></div><div><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 33.0px; background-color: #cbc5c2"><font face="Verdana" size="7" color="#082031" style="font: 30.0px Verdana; color: #082031">Antibiotic prescribing cut by three-quarters following NICE advice</font></p> <br><img src="cid:EE4C217C-9A21-4B0D-9CF4-B05F03943CC9@local"><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; line-height: 16px; font: normal normal normal 12px/normal Verdana; color: rgb(74, 66, 62); min-height: 15px; "><br></div><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">NICE guidance has helped to cut down on unnecessary antibiotic prescribing for the prevention of infective endocarditis, latest research suggests.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">Antibiotic prophylaxis prescribing fell by 78.6 per cent following the introduction of NICE guidelines for infective endocarditis - an infection of the lining of the heart that is caused mainly by bacteria but occasionally by other infectious agents.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">Despite advances in diagnosis and treatment, infective endocarditis remains a life-threatening disease with significant mortality of around 20 per cent.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">Antibiotics have been offered routinely for more than 50 years as a preventative measure to people at risk of infective endocarditis.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">However, there is little evidence to support this practice and any benefits from antibiotic prophylaxis need to be weighed against the risks of adverse effects for the patient and of developing antibiotic resistance.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">As a result, NICE <a href="http://www.nice.org.uk/nicemedia/live/11938/40014/40014.pdf"><font color="#984143" style="color: #984143">recommended</font></a> in March 2008 that antibiotic prophylaxis should no longer be offered routinely for all patients at risk of infective endocarditis undergoing dental and a wide range of other invasive procedures.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">Researchers, led by Professor Martin Thornhill, from the University of Sheffield, School of Clinical Dentistry, decided to assess the impact of the NICE guidelines by studying national prescribing data in England, as well as data recorded for all inpatient hospital activity in the UK.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">They found that in the 12 months after the introduction of the NICE guideline, the prescribing of antibiotic prophylaxis for infective endocarditis declined rapidly.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">In order to compare more stable periods of prescribing for antibiotic prophylaxis, the 12 months before the introduction of the guideline was compared with the most recent 12 months of prescribing data. This resulted in a 78.6 per cent reduction in antibiotic prescribing following the launch of the NICE guidelines.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">The reduction in antibiotic use did not cause an increase in cases of infective endocarditis or in the number of deaths from the disease.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">Writing in the <a href="http://www.bmj.com/content/342/bmj.d2392"><font color="#984143" style="color: #984143">British Journal of Medicine</font></a>, the researchers say that the decrease in prescribing of antibiotics in the months after the introduction of the guideline was large and suggests much better compliance than is often seen after policy changes in medicine, with particularly good compliance among dentists.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font color="#4a423e" style="font: 12.0px Verdana; color: #4a423e"><b><font class="Apple-style-span" size="4"><span class="Apple-style-span" style="font-size: 14px; ">They concluded that the findings “support the cessation of antibiotic prophylaxis before dental and other invasive procedures.”</span></font></b></font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">The recommendations advising against the use of antibiotic prophylaxis to prevent infective endocarditis can also be found on the NICE website as part of the <a href="http://www.nice.org.uk/usingguidance/donotdorecommendations/index.jsp"><font color="#984143" style="color: #984143">“do not do” database</font></a>.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e">The database contains recommendations on clinical practices that should be discontinued completely or should not be used routinely in the NHS, and contains recommendations that have been made since 2007, taken from NICE cancer service guidance, clinical guidelines, interventional procedures and technology appraisals guidance.</font></p><p style="margin: 0.0px 0.0px 10.0px 0.0px; line-height: 16.0px"><font face="Verdana" size="3" color="#4a423e" style="font: 12.0px Verdana; color: #4a423e"><b>6 May 2011</b></font></p><br><div> <span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: medium; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: medium; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div><div>----</div><div>Dr. Edgardo Schapachnik</div><div><a href="mailto:edgardoschapachnik@grupoakros.com.ar">edgardoschapachnik@grupoakros.com.ar</a></div><div>Presidente de la Asociación "Carlos Chagas"</div><div>Director General y Científico Grupo AKROS</div></div></span><span></span><div>-------------</div><div><font class="Apple-style-span" size="1"><span class="Apple-style-span" style="font-size: 9px; "><b><i><font class="Apple-style-span" color="#FF0000">Hay hombres que luchan un día y son buenos.</font></i></b></span></font></div><div><font class="Apple-style-span" size="1"><span class="Apple-style-span" style="font-size: 9px; "><b><i><font class="Apple-style-span" color="#FF0000">Hay otros que luchan un año y son mejores.</font></i></b></span></font></div><div><font class="Apple-style-span" size="1"><span class="Apple-style-span" style="font-size: 9px; "><b><i><font class="Apple-style-span" color="#FF0000">Están los que luchan toda la vida: esos son los imprescindibles.</font></i></b></span></font></div><div><font class="Apple-style-span" size="1"><span class="Apple-style-span" style="font-size: 9px; "><b><i><font class="Apple-style-span" color="#FF0000">Bertold Brecht</font></i></b></span></font></div><span class="Apple-style-span" style="border-collapse: separate; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-border-horizontal-spacing: 0px; -webkit-border-vertical-spacing: 0px; -webkit-text-decorations-in-effect: none; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><br class="Apple-interchange-newline"></span></span></span></span></span><br class="Apple-interchange-newline"></span> </div><br></div></body></html>