Bacterial meningitis and other stories . . .

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5167 (Published 20 August 2014) Cite this as: BMJ 2014;349:g5167

After the overload of opinion about statins in the past few weeks, Minerva commands that there should be a cooling-off period until the end of the year. Before that comes into force, she would like to draw attention to an article in Circulation: Cardiovascular Quality and Outcomes (2014, doi:10.1161/CIRCOUTCOMES.114.000825) with the title “Combining network meta-analysis with multicriteria decision analysis to choose among multiple drugs.” The authors look at the six available statins and the known information about their benefits and adverse effects together with the degree of uncertainty. They suggest that this approach needs to be adopted for every drug class when sharing decisions with patients: quite a challenge.

In some clinical situations, however, shared decision making has to give way to urgent lifesaving treatment following a protocol. Acute bacterial meningitis is an example, and guidelines from the Infectious Diseases Society of America summarise current evidence into a straightforward algorithm for its management. Yet when investigators …

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