Important to check whether your medication is approved for your condition

There is a new study out that suggests that 12 percent of drugs doctors prescribe are for uses other than those approved by regulators. These are know as "off-label" since they are not prescribed for their approved use. While this doesn't always mean a negative outcome, patients should be encouraged to ask their doctor if the drug they are getting is for an approved use, since they sometimes have negative side effects.

To get a better understanding of off-label, the drug label of FDA-approved drugs gives information about the drug, including the approved doses and how it's to be given to treat the medical condition for which it was approved. When a drug is used in a way that is different from that described in the FDA-approved drug label, it is said to be an "off-label" use. This can mean that the drug is:

·        Used for a different disease or medical condition.

·        Given in a different way (such as by a different route).

·        Given in a different dose.

·          

For example, when a chemotherapy drug is approved for treating one type of cancer, but is used to treat a different cancer, it is off-label use.

Off-label is also called "non-approved" or "unapproved" use of a drug. New uses for these drugs may have been found, and often medical evidence supports the new use. But the makers of the drugs have not put them through the formal, lengthy, and often costly studies required by FDA to officially approve the drug for new uses.

It’s not a surprise that the Food & Drug Administration is studying this issue and offers the following recommendations:
 
If you and your Healthcare Provider are considering off-label use of an approved drug, consider asking these questions before deciding whether it is right for you.

·        Is there information available to support the off-label use of this drug to treat my condition?

·        Is this off-label drug likely to work better than an approved drug?

·        What are the risks and benefits of off-label treatment with this drug?

·        Will my health insurance cover off-label treatment with this drug?  

One of the findings of the aforementioned study according to the Wall Street Journal is that “doctors often don’t know if the reason for the prescribing of a drug is off-label. They typically choose a drug based on other patients’ experiences with similar conditions or clinical guidelines from professional organizations.”

Some examples of off-label use include:
Quinine, which is approved for malaria, but is often prescribed for nocturnal leg pain.
Quetipine, which is approved for bipolar disorder, is often prescribed for dementia insomnia.
Does this pose a danger?  Not usually, and in many cases, it works to alleviate many conditions.

It’s probably a good idea to have discussion with your health care provider concerning your current medications and any new medications that may be prescribed.
Pharmacists are the drug specialists, ask for a medication review with your local pharmacist.

Are we overusing antibiotics in nursing homes?

Overuse of antibiotics can interfere with treatment of certain heath conditions


Antibiotics have played a critical role in treating a variety of diseases.   But new research has found that overuse of antibiotics is creating a rise in drug-resistant infections, especially in nursing homes where urinary tract infections (UTI) are an ongoing problem.

The issue is that overuse of antibiotics has led to the rise in dangerous drug-resistant infections.  A bacterium is resistant to a drug when it has changed in some way that either protects it from the action of the drug or neutralizes the drug. Any bacterium that survives an antibiotic treatment can then multiply and pass on its resistant properties. Also, some bacteria can transfer their drug-resistant properties to other bacteria, helping them thrive.

The fact that bacteria develop resistance to a drug is normal and expected. However, the way that drugs are used affects how quickly and to what extent drug resistance occurs.
Up to 70% of nursing home residents receive one or more courses of antibiotics every year for urinary tract infections, pneumonia, cellulitis and other suspected conditions, according to researchers. Yet according to a Wall Street Journal story, up to 75% of those prescriptions are given incorrectly—either unnecessarily or the prescription is for the wrong drug, dose or duration, the Centers for Disease Control and Prevention says.
One of the biggest culprits, researchers say is misdiagnosed urinary tract infections. Only a quarter to a third of people in nursing homes who are diagnosed have actual symptoms, according to several studies. Most have only vague symptoms like confusion or bacteria in their urine that aren’t actually causing an infection.
There is increasing evidence that such practices can lead to the spread of drug-resistant bacteria. This is particularly harmful to the elderly and are very difficult if not impossible to treat, researchers say. They can also lead to drug interaction problems or diarrhea from Clostridium difficile—a common complication in long-term care facilities that can be deadly for people over age 65,
Nursing homes can contribute to this since doctors can be reluctant to hold off on prescribing, and on top of that, turnover in nursing home staff is high. So antibiotics can be prescribed without the proper monitoring.
Geriatricians are attacking the issue by trying to dispel a myth that confusion alone or even a fall signals a possible urinary tract infection.  Instead, patients should be checked for actual UTI symptoms such as fever, pelvic pain, incontinence or urgency to urinate, and urine tests should be done only on those with UTI symptoms, according to guidelines and campaigns issued in recent years by several professional societies. Often times, clients and their families do not recognize the symptoms of UTI and elderly do not always have pain as a UTI symptom.
Common viral infections that do not benefit from antibiotic treatment include:
Cold
Flu (influenza)
Bronchitis
Most coughs
Most sore throats
Some ear infections
Some sinus infections
Stomach flu (viral gastroenteritis)

In spite of a growing awareness of antibiotic resistance in recent years, overuse still occurs for a number of reasons:
Doctors may prescribe antibiotics before receiving test results that identify the actual cause of infection.
People who want quick relief from symptoms, regardless of the cause of illness, may pressure doctors for antibiotic prescriptions.
People may take antibiotics purchased abroad or via the Internet for self-diagnosed illnesses.
People may take antibiotics that are leftovers from a previous prescription.

One of the benefits of at-home care is that home health aides closely monitor patients so they can help detect UTIs early or if another cause is indicating a UTI symptom.. And if a patient is on antibiotics, home health aides can determine how long a patient is on the antibiotics and discuss this with a physician.
This can help minimize discomfort and potential drug interactions.