Clopidogrel is a safe effective treatment for most people with acute myocardial infarction

The antiplatelet drug clopidogrel should be added to standard treatments for patients with acute myocardial infarction, say the authors of a large placebo controlled trial. It's relatively cheap, safe, and when combined with aspirin produces benefits equivalent to nine fewer serious events (death, further heart attack, or stroke) for every 1000 people treated for about two weeks.

The trial involved 45 852 patients from all over China. They got to hospital a mean of 10 hours after their symptoms started. All had aspirin, just over half were given fibrinolytic drugs, and three quarters were given anticoagulants, mostly heparin. Half the patients also had intravenous then oral metoprolol, as part of a sister trial. None had a percutaneous coronary intervention.

Addition of clopidogrel 75 mg daily to these other treatments reduced the risk of death, further heart attack, or stroke relative to placebo (2121 events (9.2%) v 2310 (10.1%), P = 0.002). Clopidogrel also reduced overall mortality in hospital (1726 deaths (7.5%) v 1845 (8.1%), P = 0.03), the first new drug treatment to do so for 10 years. Clopidogrel did not increase the risk of serious bleeding, including haemorrhagic stroke.

Lancet 2005;366: 1607-21

Strategies to control antibiotic prescribing must go beyond the sore throat

Antimicrobial resistance is a global threat to health, and we are not doing nearly enough to combat it, writes a specialist from the US Centers for Disease Control and Prevention. Profligate and inappropriate prescribing of broad spectrum antibiotics is one of the biggest problems, yet interventions to change doctors' behaviour and patients' expectations have focused on only a small number of upper respiratory tract infections such as sore throat.

The situation is becoming critical as drug manufacturers slowly withdraw from the antibiotic market. With fewer new compounds being licensed, the pressure is on to preserve the effectiveness of the antibiotics we already have. Fluoroquinolones are …