New epidemiological study in malignant hyperthermia reinforces the effectiveness of Dantrium® in reducing fatal anaesthetic reaction

Main Category: Pain / Anesthetics
Also Included In: Clinical Trials / Drug Trials;  Surgery
Article Date: 20 Aug 2013 - 1:00 PDT Current ratings for:
New epidemiological study in malignant hyperthermia reinforces the effectiveness of Dantrium® in reducing fatal anaesthetic reaction

For the first time, a new Canadian epidemiologic study reveals that a 15.5 per cent incidence of adverse anaesthetic reactions is triggered by succinylcholine alone. In line with previous findings, the study also further underlines that early recognition and prompt administration of dantrolene intravenous are critical for patient survival and reduction of complications.[1]

The study reviews one hundred twenty-nine proband* survivors of adverse anaesthetic reactions, whose malignant hyperthermia susceptible status was confirmed by caffeine-halothane contracture testing. Among the findings are lower than expected complication rates in anaesthetising facilities using either succinylcholine or volatile anaesthetic drugs.

Importantly, it also reports that dantrolene reduced the incidence of complications (e.g. renal and cardiac dysfunction, disseminated intravascular coagulation) in these patients. If given between 10 and 19 minutes after the start of malignant hyperthermia, the complication rate is under 20 per cent. An escalating relationship between time to administration was identified, showing that complications can reach 100 per cent when the administration of dantrolene was delayed beyond 50 minutes.

This study is worth noting because it also highlights how having dantrolene readily available can reduce the morbidity and mortality caused by malignant hyperthermia and therefore suggests the importance of reviewing stock levels in hospitals.

The incidence of malignant hyperthermia varies greatly among different populations due to genetic diversity. Recent data suggest the genetic predisposition may be as prevalent as 1 in 3,000 people.[2]

Dr Gunilla Islander, Department of Anaesthesia, Lund hospital, Sweden commented; "These new data are very important as they emphasize that survival from a malignant hyperthermia crisis, a rare condition, is highly dependent on early recognition and prompt action, and that the rapid use of dantrolene can ensure patient survival".

In Europe, DANTRIUM® (dantrolene) is commercialised by Norgine B.V. In December 2012, Norgine B.V. with the owners of SpePharm Holding B.V., created a joint venture company, SpePharm AG, which acquired the specialist hospital products of SpePharm Holding B.V. - DANTRIUM® IV, DANTRIUM® capsules, SAVENE®, XEROTIN® and PROTHER®.

About Malignant Hyperthermia
Malignant hyperthermia is an inherited, rare, life-threatening condition. Triggers for malignant hyperthermia include skeletal muscle relaxants such as succinylcholine and certain volatile anaesthetic gasses, one example of which is halothane.

Early recognition of a pending malignant hyperthermia crisis and immediate treatment are essential for the patient's survival.

About dantrolene (DANTRIUM®)
Dantrolene IV is indicated for malignant hyperthermia and acts peripherally to lower the intracellular calcium concentration in the skeletal muscle.

This occurs by decreasing the release of calcium ions from the sarcoplasmic reticulum and inhibiting the influx of calcium into the myoplasm. Therefore, it effectively slows or stops the cycle of malignant hyperthermia.

Dantrolene oral capsule(s) is a muscle relaxant indicated for chronic spasticity. It is the only agent that acts directly at the level of the skeletal muscle and it therefore has a unique place among the muscle relaxants prescribed.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pain / anesthetics section for the latest news on this subject.

*Malignant hyperthermia often has a familial genetic lineage (autosomal dominant). In this study probands are individuals who presented with the first known cases of malignant hyperthermia in their families. These subjects then had a Caffeine-Halothane Contracture Test, a gold-standard test used widely in North America to confirm susceptibility to malignant hyperthermia.

[1] Sheila Riazi et al. Malignant Hyperthermia in Canada: Characteristics of Index Anesthetics in 129 Malignant Hyperthermia Susceptible Probands. Anesth Analg. 2013 Jul 10. [Epub ahead of print], doi: 10.1213/?ANE.0b013e3182937d8b

[2] Glahn et al. Recognizing and managing a malignant hyperthermia crisis: guidelines from the European Malignant Hyperthermia Group. British Journal of Anaesthesia 105 (4): 417-20 (2010), doi: 10.1093/bja/aeq243

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Reducing resistance to antibiotics via reduction campaigns not always successful

Main Category: MRSA / Drug Resistance
Also Included In: Public Health
Article Date: 31 Jul 2013 - 0:00 PDT Current ratings for:
Reducing resistance to antibiotics via reduction campaigns not always successful

Antibiotic use - and misuse - is the main driver for selection of antibiotic resistant bacteria. This has led many countries to implement interventions designed to reduce overall antibiotic consumption. Now, using methicillin resistant Staphylococcus aureus (MRSA) as an example, Laura Temime of the Conservatoire National des Arts et Metiers, Paris, and collaborators warn that simply reducing antibiotics consumption does not necessarily reduce resistance. The research is published online ahead of print in Antimicrobial Agents and Chemotherapy.

The success of antibiotic reduction programs depends on which antibiotics are reduced, because some select more strongly for resistance than others. For instance, in the case of S. aureus, reducing use of clindamycin and methicillin lead to decreased resistance, while reducing use of penicillins does not, since most S. aureus, including MRSA, are already resistant to penicillin, explains Temime.

Additionally, efforts to reduce antibiotic use must be coordinated between hospitals and the community, since either can feed resistant bacteria into the other, undermining reduction efforts, says Temime.

In 2002-2003, a national program reduced antibiotic use in France by 10 percent. However, it fell short of the full potential for reducing resistance because it failed to target those antibiotics that generate the most resistance, says Temime. She and her collaborators developed a mathematical model of MRSA circulation, which correctly simulated that reduction, post-facto. They then performed a number of simulations of reductions in antibiotic use, which demonstrated the complexities of reduction efforts.

"We found that the reduction in MRSA hospital rates could have been much larger than it actually was following the 2002 antibiotic reduction campaign," says Temime. "Our results also suggest that changes in the distribution of antibiotics prescribed for non-hospitalized patients actually limited the impact of the antibiotic reduction campaign in French hospitals."

Their research shows that class-specific changes in antibiotic use, rather than overall reductions, need to be considered in order to achieve the greatest benefit from antibiotic reduction campaigns, says Temime. "This underlines the importance of generating surveillance data on both antibiotic class-specific changes in antibiotic use and antibiotic resistance in the years following an antibiotic reduction campaign. We believe that this research may help health policy makers and physicians in the design of more efficient antibiotic reduction campaigns."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our mrsa / drug resistance section for the latest news on this subject.

Lidia Kardas-Sloma, Pierre-Yves Boëlle, Lulla Opatowski, Didier Guillemot and Laura Temime, Antibiotic reduction campaigns do not necessarily decrease bacterial resistance: the example of methicillin-resistant S. aureus, Antimicrobial Agents and Chemotherapy, Published ahead of print 1 July 2013, doi: 10.1128/AAC.00711-13

American Society for Microbiology

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'Reducing resistance to antibiotics via reduction campaigns not always successful'

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Reducing resistance to antibiotics via reduction campaigns not always successful

Main Category: MRSA / Drug Resistance
Also Included In: Public Health
Article Date: 31 Jul 2013 - 0:00 PDT Current ratings for:
Reducing resistance to antibiotics via reduction campaigns not always successful

Antibiotic use - and misuse - is the main driver for selection of antibiotic resistant bacteria. This has led many countries to implement interventions designed to reduce overall antibiotic consumption. Now, using methicillin resistant Staphylococcus aureus (MRSA) as an example, Laura Temime of the Conservatoire National des Arts et Metiers, Paris, and collaborators warn that simply reducing antibiotics consumption does not necessarily reduce resistance. The research is published online ahead of print in Antimicrobial Agents and Chemotherapy.

The success of antibiotic reduction programs depends on which antibiotics are reduced, because some select more strongly for resistance than others. For instance, in the case of S. aureus, reducing use of clindamycin and methicillin lead to decreased resistance, while reducing use of penicillins does not, since most S. aureus, including MRSA, are already resistant to penicillin, explains Temime.

Additionally, efforts to reduce antibiotic use must be coordinated between hospitals and the community, since either can feed resistant bacteria into the other, undermining reduction efforts, says Temime.

In 2002-2003, a national program reduced antibiotic use in France by 10 percent. However, it fell short of the full potential for reducing resistance because it failed to target those antibiotics that generate the most resistance, says Temime. She and her collaborators developed a mathematical model of MRSA circulation, which correctly simulated that reduction, post-facto. They then performed a number of simulations of reductions in antibiotic use, which demonstrated the complexities of reduction efforts.

"We found that the reduction in MRSA hospital rates could have been much larger than it actually was following the 2002 antibiotic reduction campaign," says Temime. "Our results also suggest that changes in the distribution of antibiotics prescribed for non-hospitalized patients actually limited the impact of the antibiotic reduction campaign in French hospitals."

Their research shows that class-specific changes in antibiotic use, rather than overall reductions, need to be considered in order to achieve the greatest benefit from antibiotic reduction campaigns, says Temime. "This underlines the importance of generating surveillance data on both antibiotic class-specific changes in antibiotic use and antibiotic resistance in the years following an antibiotic reduction campaign. We believe that this research may help health policy makers and physicians in the design of more efficient antibiotic reduction campaigns."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our mrsa / drug resistance section for the latest news on this subject.

Lidia Kardas-Sloma, Pierre-Yves Boëlle, Lulla Opatowski, Didier Guillemot and Laura Temime, Antibiotic reduction campaigns do not necessarily decrease bacterial resistance: the example of methicillin-resistant S. aureus, Antimicrobial Agents and Chemotherapy, Published ahead of print 1 July 2013, doi: 10.1128/AAC.00711-13

American Society for Microbiology

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

American Society for Microbiology. "Reducing resistance to antibiotics via reduction campaigns not always successful." Medical News Today. MediLexicon, Intl., 31 Jul. 2013. Web.
31 Jul. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Reducing resistance to antibiotics via reduction campaigns not always successful'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here