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Abstract Early paracetamol increases asthma risk? Exposure to paracetamol in early life is associated with an increased risk of asthma and related conditions at age six to seven, according to a multinational case‐control study ( Lancet 2008; 372:1039‐48). ISAAC‐3 included 205 487 children aged six to seven in 31 countries. Treatment of fever with paracetamol in the first year of life (as recollected by parents) was associated with an increased risk of asthma symptoms at age six to seven (odds ratio, OR, 1.46), and also with rhinoconjunctivitis and eczema. Compared with no use, ORs for asthma with medium and high current use were 1.61 and 3.23 respectively. Further PPI fractures Further evidence of a link between long‐term use of a PPI and an increased risk of osteoporotic fractures has emerged from Canada ( CMAJ 2008; published online doi10.1503/cmaj. 071330). The case‐control study compared the use of PPIs by 15 792 patients with osteoporotic fractures and 47 289 controls. PPI use for up to six years was not associated with increased risk of osteoporosis‐related fracture, but after seven years the risk was almost doubled. The risk of hip fracture specifically was increased by 60 per cent after five years' PPI use and quadrupled after seven or more years' use. This is the third observational study to link PPIs with increased fracture risk. Half of drug‐related admissions preventable Almost half of hospital admissions due to the adverse effects of medication are avoidable, researchers from The Netherlands suggest ( Arch Intern Med 2008;168(17):1890‐6). Screening 130 000 admissions, they identified 5.6 per cent associated with adverse effects or medication errors with an average length of stay of eight days; of these, 47 per cent could have been prevented. Approximately 15 per cent were associated with death or postdischarge disability, though causality was not assessed. Admission was due to impaired cognition, four or more co‐morbidities, being dependent, impaired renal function, nonadherence and polypharmacy. The drugs most frequently implicated were antiplatelet drugs, anticoagulants and NSAIDs. Mental health survey The Healthcare Commission's fifth annual survey has revealed small improvements in services for people with mental health problems ( www.healthcarecommission.org.uk ). Forty‐four per cent of respondents said they now had a say in decisions about medication (up from 40 per cent in 2004) and 32 per cent of those newly prescribed treatment said they were not given enough information about adverse effects (down from 35 per cent). Once‐weekly exenatide? Once‐weekly injections of exenatide (Byetta) may offer superior glycaemic control to twice‐daily injections, a US study suggests ( Lancet 2008; published online DOI:10. 1016/S0140‐6736(08) 61206‐4). The nonblinded study compared the licensed regimen (10μg twice daily) with once‐weekly injections of 2mg in 295 patients with poorly controlled type 2 diabetes. After 30 weeks, weekly injections reduced HbA1c by more (‐1.9 vs ‐1.5 per cent) and achieved target HbA1c in more patients (77 vs 61 per cent). There were similar reductions in body weight and no increased risk of hypo‐glycaemia. Toctino for hand eczema Alitretinoin (Toctino), an oral retinoid, has been introduced for the treatment of severe chronic hand eczema in adults unresponsive to potent topical steroids. Like other retinoids, it is teratogenic and is contraindicated during pregnancy. At the recommended dose of 10‐30mg per day, a month's treatment costs £411.43. Latest BNF updates The 56th edition of the British National Formulary has now been published in hard copy and online ( www.bnf.org ). It includes updated prescribing information on lipid‐lowering drugs to prevent cardiovascular disease, and guidance on the management of atrial fibrillation and the application and labelling of topical steroids. Tables on the management of acute asthma and HRT risk have been revised and new safety data include the risk of hypersensitivity with penicillins and cephalosporins and suicidal behaviour with antiepileptic drugs. Candesartan and retinopathy Candesartan (Amias) reduces the incidence of new‐onset retinopathy in type 1 diabetic patients by 18 per cent and reduces the progression of established retinopathy in patients with type 2 diabetes by 13 per cent, according to the DIRECT study presented recently at the European Association for the Study of Diabetes (EASD) conference. However, despite what trialists describe as encouraging results, neither of these primary endpoints reached significance. Candesartan did significantly increase regression of retinopathy in type 2 diabetics by 34 per cent. The DIRECT study, involving 5000 patients over four to six years, is the first large‐scale randomised trial to look at the effect of an angiotensin‐II receptor blocker (ARB) on prevention and progression of retinopathy in type 1 and 2 diabetic patients. Candesartan 32mg was added to usual therapy and the patients were normotensive or had controlled hypertension. All patients were normoalbuminuric and candesartan had no impact on the development of microalbuminuria. Use of iv metronidazole The MHRA has pointed out that our statement that metronidazole should be administered orally, not by intravenous injection, for the treatment of C. difficile ‐associated diarrhoea (CDAD) is incorrect (News, 5 September issue, page 11). Their latest Drug Safety Update (2008;2:Issue 1) states that the iv formulation of metronidazole can be used for this indication in exceptional cases by CDAD specialists. Copyright © 2008 Wiley Interface Ltd

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