Adding the results of a recently published clinical study to a previous Cochrane review has led to a major shift in thinking. The authors now say that doctors should stop routinely giving steroids after severe brain injury because it increases death rates.

Traumatic brain injury is a leading cause of death and disability. In the US alone, over 33,000 people suffer some form of brain injury related disability each year. Since early reports of benefit in the 1960s, doctors have used corticosteroids as part of the treatment. A previous version of this review had said there was insufficient evidence to be certain about the benefits of the treatment.

Because of the inconclusive earlier review, the UK Medical Research Council set up a large trial to address this question. "The CRASH trial was larger than all the other trials put together, and gave a clear result that patients given steroids have a greater chance of dying than those who did not receive them," says Dr Phil Alderson of the UK Cochrane Centre in Oxford, who wrote the review along with Prof Ian Roberts of the London School of Hygiene and Tropical Medicine.

The Cochrane authors' conclusion is unequivocal stop using corticosteroids routinely for people with traumatic head injury.

Review title: Alderson et al: Corticosteriods for acute traumatic brain injury. The Cochrane Database of Systematic Reviews 2005, Issue 1

-------------------------

Don't take antibiotics for acute laryngitis

Penicillin V and erythromycin give little or no benefit to people suffering from acute laryngitis. Taking them only runs the risk of stimulating the growth of antibiotic resistant bacteria.

Winter is a time when many people find their throat sore, the voice hoarse and they have a fever and difficulty swallowing. Correctly thinking they have laryngitis they head off to
'"/>

Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
23-Jan-2005