Ann Intern Med 17 Apr 2007 Vol 146

A big group of Canadians make a valiant attempt to determine which inhalers really benefit patients with chronic obstructive airways disease. The idea was to start with tiotropium and randomise to salmeterol or salmeterol-fluticasone or placebo. But this was the messy world of real-life, breathless, elderly people with smoking-related lung damage: 40% of the patients crossed groups or were given unblinded extra treatment. So although it’s probable that salmeterol alone is useless, it’s not entirely certain that salmeterol with a steroid really has a useful effect on exacerbations either, though it might have. There was no difference on the exacerbation rate itself in this group, but the patients tended to feel better and ended up in hospital less.

Eradication of Helicobacter pylori using a standard three-drug combination is becoming less effective as time goes on, so an Italian team decided to do a double-blinded trial of sequential treatment instead. This consisted of high-dose amoxicillin and pantoprazole for five days, followed by pantoprazole, clarithromycin and tinidazole for 5 days. I guess the potential combinations are endless, but this one produced an eradication rate of 89%, compared to 77% with a ten-day regime of pantoprazole, clarithromycin and amoxicillin.
The clinical discussion treatments for knee osteoarthritis in this week’s JAMA doesn’t rate chondroitin highly, and that’s the message of this systematic review. There is no evidence that it works, and much to suggest it doesn’t.