Omega-3 Supplementation Delays Transition to Psychotic Disorder in Ultra-High Risk Adolescents and Young Adults

DynaMed Weekly Update - Volume 5, Issue 8

Polyunsaturated fatty acid (PUFA) supplementation has been studied for treatment of schizophrenia although the evidence to date has been inconclusive ( Cochrane Database Syst Rev 2009 Jul 8;(3):CD001257). In a recent randomized trial evaluating PUFAs as a preventive intervention, omega-3 polyunsaturated fatty acid supplementation decreased the transition to a psychotic disorder in ultra-high risk adolescents and young adults (level 1 [likely reliable] evidence). Eighty-one patients aged 13-25 years at ultra-high risk of psychotic disorder were randomized to omega-3 (1.2 g/day) vs. placebo for 12 weeks and then followed for 1 year. All participants had subthreshold psychosis and either attenuated positive psychotic symptoms, transient psychosis, or genetic risk with decreasing functioning. After 1 year, transition to a psychotic disorder requiring antipsychotic medication had occurred in 4.9% of patients receiving supplements compared to 27.5% in those receiving placebo (p = 0.007, NNT 5). Omega-3 supplementation was also associated with a significant reduction in symptoms and improvement in global assessment of functioning (Arch Gen Psychiatry 2010 Feb;67(2):146).

For more information, see the Schizophrenia topic in DynaMed.

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In Children with AOM, Amoxicillin May Have Lower Rate of Clinical Failure Compared to Azithromycin

When antibiotics are needed for treating acute otitis media (AOM) in children, amoxicillin is the first-line agent recommended by the American Academy of Pediatrics. Macrolides, such as azithromycin or clarithromycin, are recommended as alternatives for patients with type 1 hypersensitivity reactions. A recent systematic review of low-quality trials comparing macrolide antibiotics (azithromycin and clarithromycin) to amoxicillin-containing antibiotics for AOM in children found that macrolide antibiotics were associated with a modest increase in risk of clinical failure (level 2 [mid-level] evidence). Ten randomized trials compared these macrolide antibiotics with amoxicillin or amoxicillin plus clavulanate in 2,766 children aged 6 months to 15 years with AOM. The risk of clinical failure was increased with macrolide antibiotic use (relative risk [RR] 1.3, 95% CI 1.07-1.6, NNH 32 [range from meta-analysis 21-56]). In subgroup analyses, azithromycin had a significantly higher rate of failure (RR 1.34, 95% CI 1.06-1.7) compared to amoxicillin-containing antibiotics, but clarithromycin trials showed no significant difference in failure rates (RR 1.17, 95% CI 0.65-2.12). Macrolide antibiotic use was also associated with significantly reduced adverse effects, including risk of diarrhea. A trend toward higher failure rates with macrolides was observed in children younger than 4 years old (Ann Pharmacother 2010 Mar;44(3):471).

For more information, see the Acute otitis media topic in DynaMed.


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