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.


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.