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Superbug Prevention | Public Health Update

From eNewsletter 2/26/2020

DID YOU KNOW that 2020 is a leap year? Adding an extra day every four years keeps our calendar aligned correctly with the astronomical seasons, since a year according to the Gregorian calendar (365 days) and a year according to Earth's orbit around the Sun (approximately 365.25 days) are not the exact same length of time. Without this extra day, our calendar and the seasons would gradually get out of sync. Because of this extra day, a leap year has 366 days instead of 365.


Steve & Bonnie: We post an alert every three to four months.

Superbug Prevention

Antibiotics are not the only class of drug contributing to superbug proliferation. According to a study from Monday's JAMA Internal Medicine, acid suppression from reflux medication (OTC or prescription) is associated with increased odds of multidrug-resistant microorganisms colonization (superbugs). In view of the global increase in antimicrobial resistance, the authors suggest stewardship to reduce unnecessary use of acid suppressants to prevent multidrug-resistant microorganisms colonization.

There's yet another issue with reflux medication. Continuous use of proton pump inhibitors (PPIs) may cause acute stomach flu (viral gastroenteritis), according to a study in JAMA Network Open. The finding adds to existing evidence that physicians should deprescribe PPIs when possible to reduce potential adverse events.


Women who take macrolide antibiotics during the first trimester of pregnancy have an increased risk of their child having a major malformation, according to authors of a BMJ study, who urge caution in the use of the drugs throughout pregnancy. Macrolide antibiotics include erythromycin, clarithromycin, and azithromycin, and are among the most frequently prescribed antibiotics during pregnancy. Specifically, erythromycin use in the first trimester was linked to a 50% increased risk of any major malformation.

On the FDA's first 2020 watch list, eight fluoroquinolones, a class of antibiotics, were mentioned for potential signs of risk for mitral and aortic regurgitation. The FDA has issued several prior safety communications about fluoroquinolone use, including in December 2018 (aortic aneurysm), July 2018 (significant decreases in blood sugar and certain mental health side effects), July 2016 (disabling adverse effects of the tendons, muscles, joints, nerves, and central nervous system), May 2016 (restrict use for certain uncomplicated infections), August 2013 (peripheral neuropathy), and July 2008 (tendinitis and tendon rupture).


According to a new study in Family Practice, taking a baby aspirin every day to prevent a heart attack or stroke should no longer be recommended to patients who haven't already experienced one of these events. Nearly one-quarter of Americans over the age of 40 have reported taking aspirin daily even if they don't have a history of heart disease or stroke.


In a new study presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting, the risk for adverse events was 1.5 times higher for young people who received one to three prescriptions for systemic corticosteroids in a year than for those who received no prescriptions. And the rate was three times higher for those who received four or more prescriptions.

Hormone Replacement

Women who use synthetic estrogen and synthetic progesterone (progestin) hormones after menopause still have an increased risk of developing breast cancer nearly two decades after they stop taking the pills, according to long-term results from a huge federal study in 2002 called the Women's health Initiative. Of 16,000 women aged 50 to 70 with roughly 19 years of followup, 572 breast cancers have occurred in those on hormones versus 431 among those on dummy pills. That worked out to a 29% greater risk of developing the disease for hormone takers.

Nervous System Medication

The FDA added new warnings to packaging for Neurontin, Lyrica and generic versions, which are used to treat seizures, nerve pain, restless leg syndrome and other conditions. The new labels will warn doctors against prescribing the drugs with other medications that can slow breathing, including opioid painkillers.

Obesity Drug

The Food and Drug Administration asked Eisai to voluntary withdraw the obesity drug lorcaserin (Belviq and Belviq XR) after a post-marketing trial with more than 12,000 subjects revealed an increased occurrence of cancer.

Pain Management

The FDA has granted a new marketing clearance for the ActiPatch (BioElectronics Corp), an over-the-counter electromagnetic neuromodulation device for treating any musculoskeletal pain. The FDA has already been cleared to treat knee osteoarthritis and plantar fasciitis.

Statin Alternative

Some of you have already inquired about the a new statin alternative that has just entered the market, Nexletol. Here are the lovely details if you would like to read the package insert, including side effects and contraindications. As we suggest with every new medication that comes to market, wait at least two years minimum so we can track post-market side effects. Nexletol is no different.


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