A specific type of heartburn medications, proton pump inhibitors or PPIs, may increase the risk for bone fractures in kids, according to a study.
The Risk with PPIs
Doctors often prescribe PPIs for children who are more than one year old when they have been diagnosed with gastroesophageal reflux disease or GERD. This condition allows for stomach acid and food to be regurgitated, which causes discomfort for the child.
Researchers studied government records in Sweden of just over 230,000 children. Half of these children took PPIS which were prescribed by the doctors and half didn’t. After a follow-up of two years, data showed that of the children who had taken PPIs, just over 5350 of them had suffered a broken bone. For those who didn’t take PPIs, just under 4570 had a bone fracture.
According to the research, children who had used PPIs had a 11 percent higher risk for a bone fracture. Very few of them had fractures of the spine or skull. However, there were broken arms, broken legs and other fractures. Statistics showed that kids who had taken PPIs had an eight percent increase in the number of broken arms and 19 percent increase for broken bones in the leg.
The study didn’t account for physical activity differences or the amount of bone mineral density in each child, which could have an influence on the rate of fractures. The researcher said they didn’t conclude that all kids should stay away from PPIs. However, doctors should be aware of the potential risk when they prescribe the medications.
What is GERD?
Most babies spit up a little after taking a bottle or nursing. However, when they experience frequent spitting up along with feeding issues or loss of weight, it may indicate they have GERD. Normal spitting up should go away by the time they are one year old in most cases. If the issue continues or becomes worse, they may need treatment for GERD.
GERD can be caused by several factors, including a birth defect or medications. Secondhand smoke and obesity can also lead to GERD. Other factors include genetics, surgery on the abdomen and certain brain disorders.
Symptoms include vomiting, nausea and heartburn. In children, especially those who are younger, they may say they have stomach pain or pain in the chest. They may have hiccups or a feeling that food is stuck when they swallow. They may fail to gain weight or even lose weight. Children can eat less or avoid certain foods because of the GERD.
Treatment may include sleeping with the bed raised and not letting the child lie down for at least three hours after a meal. The doctor may recommend the child avoid sugar and spicy foods, chocolate, caffeine and acidic foods and drinks. They may also suggest the child eat more frequently and smaller portions.
Along with PPIs, a doctor may recommend H2 blockers or antacids. Many children do well with just the lifestyle changes, and it can prevent the need for medications which may have serious side effects.
Antibiotics Linked to Heart Problems
Scientists have been able to prove a link between certain antibiotics and heart issues. This information was published in the Journal of the American College of Cardiology. The study indicated a higher risk for two types of heart conditions when taking fluoroquinolone antibiotics.
Risks of Antibiotics
Patients who take Ciproflaxacin, known as Cipro, or other antibiotics that fall into this category have about 2.4 times more risk for developing a serious heart condition. This heart problem is aortic and mitral regurgitation, and it causes the blood to flow back into the heart. The risk is highest within the first 30 days of use.
Doctors prescribe the class of antibiotics because they are about as effective as if the patient received IV antibiotic treatment. These once-a-day pills are convenient to use but often not necessary. According to experts, they may cause major heart problems and increase resistance to antibiotics.
During the study, scientists reviewed patients who were within 30 days of taking the antibiotic, those within 31 to 60 days and those over 60 days. The results were compared to patients taking amoxicillin and azithromycin, two other antibiotics. The results indicated that the risk for this particular heart condition is higher with the fluoroquinolone use and within 30 days of taking it.
If other studies support this information, it is hoped that regulatory agencies will require the condition to be included on the list of side effects. It is also recommended that doctors look at other classes of antibiotics for infections and other diagnoses rather than relying on fluoroquinolone for the first line of defense.
This category of antibiotics is often used to treat urinary tract infections (UTI) and respiratory infections. Some of the popular choices in this class include Cipro, Floxin, Noroxin, Avelox and Levaquin. They are not without risk though, and they have been linked to nerve damage in the past.
What is Mitral and Aortic Regurgitation?
Mitral regurgitation can lead to increased blood pressure and congestion in the lungs. There may be no symptoms at first. As it becomes more severe, the patient may experience palpitations when lying down. It can lead to heart failure, which may be recognized by shortness of breath, coughing, swelling of the hands and feet and congestion around the lungs and heart.
Symptoms of aortic regurgitation are similar to mitral regurgitation. Both are blood leaks, but the aortic regurgitation allows blood to flow back from the aorta into the left ventricle while the mitral regurgitation allows blood to flow back into the atrium.
These conditions may be treated with medication, but surgery is often needed to repair the leaks. Anyone who has taken this medication should alert their doctor if they notice symptoms which could indicate heart failure. They should also tell their doctor if they have a heart condition before taking these antibiotics. As always, it’s important to pay close attention to any side effects as listed on the medication but make note of other symptoms that would not be considered normal for the person.
Drug Program Enhances Reduced Opioid Prescriptions
A study which was published in Health Affairs shows that states that have stricter requirements for drug monitoring had fewer opioids prescribed or used in hospitals than states that didn’t have these restrictions.
The study showed evidence that supported the idea of mandated reporting to reduce the risk of overdose and misuse of the highly-addictive opioid classification of drugs. These databases are statewide and help monitor the prescribing of opioid medications. It also allows providers to review information and identify patients who have patterns that increase their risk of developing an addiction. It shows drug combinations which could be dangerous and high dosages. The database also shows when multiple providers prescribe the medication. All these factors can lead to addiction.
Researchers reviewed data from 2011 to 2016. They looked at state databases and compared the number of opioid prescriptions with emergency room visits. According to the information provided, using drug monitoring program mandates reduced the number of prescriptions by almost 9 percent along with nearly 5 percent in hospital stays related to opioid use. Emergency room visits related to opioid use dropped by almost 18 percent.
Translated into actual numbers, using these programs resulted in 12,000 fewer inpatient stays at hospitals and almost 40,000 fewer trips to the emergency room each year. Converting that into dollars, it saved about $155 million. This research was only for those on Medicaid.
Treating Chronic Pain
On the other side of the story are people who are being forced to taper off these opioid painkillers because of the epidemic in opioid overdoses and addiction. Medical providers are more way of prescribing these strong painkillers, so they are reducing the dosage and gradually tapering patients off the medication.
For those who suffer from chronic pain and have been taking the drugs for years, it can be difficult to adjust. Long-term use of this classification often causes dependency, which could lead to addiction.
Opioids rewire the brain, which means they could cause negative side effects when the person is forced to reduce their use. Pain management clinics have stopped operating and doctors often quit prescribing opioids, causing patients to search for anyone who would write them a script. They may even travel to states which don’t currently have mandated programs.
Some patients have been on opioid drugs for most of a decade. They may suffer from an injury that left permanent damage or chronic illness that causes pain. The use of opioids for pain relief isn’t a new practice, but it’s one that gained traction in the 1980s and 1990s as pain became recognized as an important indicator of health.
Prescription opioids come from the same family as heroin, and all can be addictive when taken long-term. Some, such as morphine, have long been recognized for pain relief but only in extreme situations. Others, such as oxycodone, have developed a reputation for pain relief. At the same time, these drugs can lead to addiction and many patients transition from prescription pain relief to street drugs to maintain their habit. Preventing this trend is one reason for the state drug reporting program.
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