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BMJ 2007; 335 doi: (Published 13 December 2007) Cite this as: BMJ 2007;335:1234

Warfarin, insulin, and digoxin cause a third of all serious side effects in over 65s

Hospital emergency departments in the US have to deal with more than 177 000 visits a year from older people with an adverse drug event. In an analysis of routine surveillance data, oral anticoagulants or antiplatelet agents, antidiabetic drugs, and drugs with a narrow therapeutic index accounted for nearly half of all visits (47.5%, 95% CI 40.2% to 54.8%). Just three drugs—warfarin, insulin, and digoxin—accounted for a third of visits (33.3%, 27.8% to 38.7%).

The risk associated with these three commonly prescribed drugs was around 35 times higher than that associated with the official list of 41 other drugs known to be potentially dangerous for older people. This list, known as the Beers criteria, is widely used to gauge the quality of prescribing. Quality indicators that focus on warfarin, insulin, and digoxin may be more useful, say the researchers. Small improvements in prescribing and monitoring of these drugs could have an important effect on the incidence of adverse drug events in people over 65.

All the events in this analysis were serious enough to justify visiting an emergency department. Clinically obvious bleeding was the most common adverse event associated with warfarin (73% of events). Hypoglycaemia, often with unconsciousness or seizures, was the most common event associated with insulin (95.4%).

Antibiotics and intranasal steroids don’t help in sinusitis

Patients presenting to their primary care doctor with symptoms typical of bacterial sinusitis are unlikely to get any relief from antibiotics or topical corticosteroids according to a randomised trial from the UK. Neither treatment—alone or in combination—improved symptoms better or faster than placebo.

The 240 adults took amoxicillin 500 mg three times daily for seven days, 200 μg a day of budesonide into each nostril for 10 days, both treatments, or a double placebo. Just over two thirds of participants were completely better within 10 days, whatever their …

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