BMJ 9 Dec 2006

‘Tis the season to be sending in patients with chest infections, known as community acquired pneumonia in today’s parlance. Unless the patient is worryingly ill, we’ve usually tried oral antibiotics for some time before we send them to hospital, but it isn’t clear that whether this was the case in this Dutch trial comparing short and long courses of in-hospital intravenous antibiotics. We tend to ascribe almost magical properties to antibiotics given through a vein, but all this does is ensure high peak concentrations (and low troughs): within three days, the antibiotic can be taken orally without any difference in outcome for hospitalised severe pneumonia.

Another trial from the Netherlands, a mythical land where there are occupational therapists who can spend ten one-hour sessions with demented patients and their carers. This has benefits which, say the investigators, are still detectable after 12 weeks. Marvellous. Where I live it takes ten phone calls to get an OT to spend ten minutes with the patient and carers after a ten-month wait. This gives them time either to die or buy their own stair lift.

I’ve already summarised the management of hyperglycaemia in type 2 diabetes in commenting on the NEJM ADOPT paper, but this review comes up with three more drug classes we may soon be able to use: α-glucosidase inhibitors, meglitinides and dipeptidylpeptidase 4 inhibitors. To test when you have had enough to drink at your next Christmas party, repeat the following sentence aloud: