8 NEWS
to improve glycaemic control * for T2D patients requiring triple oral therapy 1 †
8 NEWS
6 DECEMBER 2024 ausdoc . com . au
Benign antibiotic ‘ fuelling superbug ’
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Rachel Fieldhouse PROPHYLACTIC use of the antibiotic |
agent to prevent encephalopathy for patients with liver cirrhosis . |
resistant to daptomycin despite not being exposed to the agent . |
was resistant to daptomycin than non-exposed patients . |
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rifaximin is fuelling a dangerous |
“ However , there may be impli- |
“ Instead , almost all of them had |
This relationship was also evident |
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multidrug-resistant pathogen , |
cations for patients taking rifaximin |
been receiving rifaximin ,” Professor |
in a cohort of 57 patients receiving |
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Australian scientists say . |
who develop severe infections due to |
Kwong said . |
rifaximin as antimicrobial prophylaxis |
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Writing in Nature , they say it causes |
VREfm ,” he told Australian Doctor . |
The research team , led by the Peter |
for haematopoietic stem cell trans- |
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cross-resistance to the unrelated anti- |
“ Instead of using daptomycin |
Doherty Institute for Infection and |
plantation — regardless of whether the |
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biotic daptomycin : a last-resort option |
empirically , it would be important for |
Immunity in Melbourne , performed |
patients had chronic liver disease . |
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for treating vancomycin-resistant |
laboratories to confirm that the VRE |
large-scale genomic studies on 1000 |
Bacteria with the mutations |
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Enterococcus faecium ( VREfm ). |
strain causing infection was suscepti- |
VREfm samples . |
appeared at around the same time as |
Associate Professor Jason Kwong . |
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Infectious diseases physician and study co-author Associate Professor Jason Kwong stressed the antibiotic was still effective as a second-line |
ble to daptomycin .”
The discovery followed clinical observations that several patients infected with VREfm had become
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Retrospective data for 225 patients with VREfm showed that those with recent exposure to rifaximin were more likely to have an infection that |
the approval of rifaximin as prophylaxis for hepatic encephalopathy in the early 2000s , the study authors said . Nature 2024 ; 23 Oct . |
FORXIGA ® / DPP4i
( dapagliflozin )
Working together
to improve glycaemic control * for T2D patients requiring triple oral therapy 1 †
* SIDAPVIA ® ( 10mg / 100mg ) combines FORXIGA ® ( SGLT2i ) and sitagliptin ( DPP4i ) with distinct and complementary MOA to improve glycaemic control ( HbA1c ); 1 † SIDAPVIA ® is indicated as an adjunct to diet and exercise to improve glycaemic control in adults with T2D when treatment with both FORXIGA ® and sitagliptin is appropriate . 1 SIDAPVIA ® should be used in combination with metformin unless contraindicated or not tolerated . 1
Selected Safety Information : KETOACIDOSIS – There have been reports of ketoacidosis , including DKA , a serious life-threatening condition requiring urgent hospitalisation in patients taking dapagliflozin and other SGLT2is . Fatal cases of ketoacidosis have been reported in patients taking dapagliflozin . Appropriate precautions for DKA for patients need to be taken during treatment with SGLT2i . 1 VOLUME DEPLETION AND / OR HYPOTENSION – Dapagliflozin induces osmotic diuresis which may lead to a modest decrease in blood pressure . Caution should be exercised in patients for whom a dapagliflozin-induced drop in blood pressure could pose a risk . 1 RENAL IMPAIRMENT – SIDAPVIA ® should not be used for the treatment of diabetes in patients with eGFR persistently below 45 mL / min / 1.73 m 2 . Renal function should be evaluated prior to initiation of SIDAPVIA and periodically thereafter . 1 PANCREATITIS - There have been reports of acute pancreatitis with sitagliptin . If pancreatitis is suspected , SIDAPVIA ® should be discontinued . 1 USE WITH MEDICATIONS KNOWN TO CAUSE HYPOGLYCAEMIA - Hypoglycaemia has been observed when dapagliflozin or sitagliptin was used in combination with insulin or an insulin secretagogue . Therefore , a lower dose of insulin or the insulin secretagogue may be required when used in combination with SIDAPVIA . ® 1 The adverse events with SIDAPVIA ® are consistent with the adverse events for each component . 1
PBS Information : SIDAPVIA ® & FORXIGA ® : Authority Required ( STREAMLINED ). Type 2 Diabetes . Refer to PBS Schedule for full Authority Required Information .
NOW PBS LISTED
PLEASE REVIEW FULL PRODUCT INFORMATION BEFORE PRESCRIBING SIDAPVIA ® OR FORXIGA . ® PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ASTRAZENECA ON 1800 805 342 OR BY SCANNING THIS QR CODE .
Bioequivalence has been confirmed between the SIDAPVIA ® 10 mg / 100 mg tablet and the individual dapagliflozin 10 mg and sitagliptin 100 mg tablets after single dose administration in the fasted state in healthy subjects . 1 BP , blood pressure ; DKA , diabetic ketoacidosis ; DPP4i , dipeptidyl peptidase 4 inhibitors ; eGFR , estimated glomerular filtration rate ; HbA1c , glycated hemoglobin ; MOA , mechanism of action ; SGLT2i , sodium-glucose cotransporter 2 inhibitors ; T2D , type 2 diabetes . Reference : 1 . SIDAPVIA ® Approved Product Information . SIDAPVIA ® and FORXIGA ® are registered trademarks of the AstraZeneca group of companies . Registered user AstraZeneca Pty . Ltd . ABN 54 009 682 311 . 66 Talavera Road , Macquarie Park , NSW 2113 . www . astrazeneca . com . au . For Medical Information enquiries or to report an adverse event or product quality complaint : Telephone 1800 805 342 or via https :// contactazmedical . astrazeneca . com . AU-20534 . 2565 . September 2024 .
3 stroke risk factors quantified
Rada Rouse AF , hypertension and smoking are the stand-out precursors for severe strokes compared with mild or moderate strokes , neurologists say .
The case – control INTER- STROKE study involved data on nearly 27,000 patients across 32 countries , with an average age of 62 .
It found that patients with AF had a 4.7-fold increased risk of severe stroke and 3.6 times the risk of mild to moderate stroke than people without AF .
The mean age of patients with AF was 10 years higher than those without AF , but the researchers said the effect on stroke was significant even after controlling for age .
Patients with high blood pressure ( greater than 140 / 90mmHg ) were 3.2 times more likely to have a severe stroke and 2.9 times more likely to have a mild to moderate stroke than those without high blood pressure , according to the findings published in Neurology .
This was after adjusting for age , sex and stroke type ( ischaemic or haemorrhagic ).
Current smokers had double the risk of severe stroke and 1.7 times the risk of non-severe stroke compared with former or never smokers , wrote the authors , including Professor Graeme Hankey from the University of WA .
All the risk factors examined — including diabetes , high cholesterol , alcohol use , physical inactivity and waistto-hip ratio — were associated with stroke to varying degrees .
Severity was measured by the seven-point Modified Rankin Scale .
Sixty-four per cent of patients with stroke had scores of 0-3 ( mild to moderate ), and 36 % had scores of 4-6 ( severe ). Neurology 2024 ; 13 Nov .