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Self Care Pharmacy Blog

Archive for December, 2013

 

Can Probiotics Help Prevent the Common Cold?

Monday, December 2nd, 2013

by Andrea Bashore, PharmD student

There are many types of illnesses caused by respiratory tract infections. One that we are all familiar with is the common cold. About 22 million school days are lost in America due to this sickness, and it is the leading cause of doctor’s visits and missed days of work.1 It is common for adults to contract three to four colds each year, while the elderly and young have a higher risk of catching four to six colds annually.1 An article on Natural Standard has proposed that probiotics, or “good” bacteria, can help reduce the risk for upper respiratory tract infections.2 Common ways to prevent a cold may be washing one’s hands frequently, getting plenty of rest, or dressing appropriately for cold weather. In addition to these things, it has now been found that probiotics can be an added measure against catching a cold. Most of us have probably seen probiotics advertised on yogurt such as Activia. There have been several health benefit claims about these good bacteria, and one of the most common uses is for gastric and intestinal illnesses.3 Other benefits are alleviation of lactose intolerance and food allergies, blood pressure control, and control of inflammation in arthritis.3 Along with these benefits, research has found a new use for probiotics.

The article “Probiotics May Reduce the Risk of Respiratory Tract Infections” discusses a study with new findings. Researchers recruited 465 people to participate in the study.3 They separated the participants into three different groups with the first receiving a probiotic, the second receiving a different probiotic, and the third receiving a placebo.3 The group who took probiotic BI-04 showed a significantly lower risk for an upper respiratory illness compared to the placebo group.3 Because of this comparison the researches concluded that it was an effective supplement for preventing colds.

Along with this research, there has been more evidence that supports this idea of cold prevention with probiotics. Bacteria in the nasal cavity cause upper respiratory infections, and a study in Switzerland took this into account when testing probiotics.4 They concluded that probiotics decrease the amount of this potentially illness causing bacteria.4 Another study focused on children in day care centers. They tested the same probiotics as the Switzerland study, and their results showed that use of the probiotics substantially reduced the number of respiratory tract infections in the study’s population.1

Though the conclusions from each of these articles support the claim of probiotics preventing respiratory tract infections, they cannot make the claim that probiotics directly cause this prevention. This is what the evidence shows, but we cannot say that this is a cause and effect since the articles do not give a full explanation of how this kind of good bacteria is working to prevent infection. The probiotics do not make any direct contact with the nasal cavity, though the results showed prevention of bacteria in this area.1 Even with this limitation, I would agree that probiotics are helpful and would suggest this to others. A meta-analysis done on probiotic therapy for diarrhea reported that out of four different studies no serious adverse effects were reported.5 While I believe that more studies need to be done on the safety and adverse effects of probiotics, they have not been reported to be harmful. If simply eating yogurt everyday or taking a probiotic supplement can help someone’s health through the cold season, I would gladly suggest this. I don’t think it is necessary for every person to do this, but it is something that I would recommend. There are many other ways to help prevent colds, and this is simply and additional preventative measure. Encouraging patients to take probiotics to prevent colds also opens the door to inform them of other health benefits that they may not have known.

The common cold puts a damper on our everyday lives, and using probiotics to prevent respiratory tract infections is a step towards a healthier population. This is such a simple way that we can help our communities fight the cold season.3 As pharmacists, we can easily encourage our patients to take probiotics to help prevent a cold. Can we confidently tell patients that this will be effective? How as pharmacist can we properly inform patients on probiotics and the benefits they provide? Through research and educating ourselves on this topic we can hope to better the health of our community.

 

References

  1. Snovak N, Abdović S, Szajewska H, Mišak Z, Kolaček S. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition. 2010; 29: 312-316. Available at: http://www.clinicalnutritionjournal.com/article/S0261-5614(09)00203-9/fulltext. Accessed November 2, 2013.
  2. Probiotics May Reduce the Risk of Respiratory Tract Infections. Natural Standard. 2013. Available at: http://www.naturalstandard.com/news/news201310010.asp. Accessed November 2, 2013.
  3. Parvez S, Malik KA, Kang A, Kim Y. Probiotics and their fermented food products are beneficial for health. Journal of Applied Microbiology. 2006; 100: 1171-1185. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/full. Accessed November 2, 2013.
  4. Glück U, Gebbers J. Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and hemolytic streptococci). The American Journal of Clinical Nutrition. 2003;77: 517-520. Available at: http://ajcn.nutrition.org/content/77/2/517.short. Accessed November 2, 2013.
  5. Nandini D, Costa V, MacGregor M, Brophy J. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review. Canadian Medical Assiciation Journa. 2005; 173: 167-179. Available at: http://www.cmaj.ca/content/173/2/167.full. Accessed November 25, 2013.

Quality of Life Significantly Reduced In Acetaminophen-Induced Liver Failure

Monday, December 2nd, 2013

by Calvin Anderson, PharmD student

Acetaminophen, commonly known as Tylenol, is one of several analgesics available over-the-counter and is found to help alleviate symptoms such as headaches and fevers. Other available over-the-counter analgesics include ibuprofen, naproxen, and aspirin, which have different methods of action for treating pain. Acetaminophen is the most commonly used analgesic for pain relief in patients, and often people use it as needed without properly measuring how much they are taking; this can have severe consequences that people need to be aware of.1 Overdosing on acetaminophen can eventually lead to acute liver failure, which is a serious, potentially life-threatening condition that occurs when large parts of the liver become damaged beyond repair.2 According to a news article published in US news titled “Tylenol-Induced Liver Failure Presents Own Set of Problems: Study,” a recent study showed overdose survivors of acetaminophen-induced liver failure have considerably worse mental and physical health as compared to other patients suffering from liver failure induced by other causes. This article caught my attention because it directly correlated with self-care exclusion criteria regarding proper use of acetaminophen, which states that acetaminophen is potentially toxic to the liver in doses over 4 grams per day.3

The researchers who conducted this study found that patients who over-dosed on acetaminophen were reported to have more days of poor health and reduced physical activity due to pain, anxiety and depression experienced more so than other liver failure patients. They collected data from more than 280 patients diagnosed with liver failure between 1998 and 2010, and followed them for two years. The results were reported in Liver Transplantation, and were released this past July. According to the research, adult survivors of acute liver failure have reduced quality of life as compared to those of similar age and gender in the general population. An article called “Tylenol Safety: Is there Reason to Worry?”4 mentions that acetaminophen is the most commonly used medication for pain and fever in children, and there have been numerous reports of acute liver failure in children under eighteen years of age caused by ingesting too much acetaminophen. Prescribers and pharmacists alike must let their patients know about the risks of acetaminophen before allowing them to use it, especially for those patients already suffering from a liver condition, or those who chronically consume alcohol (more than 4 drinks per day.)3

It can be concluded from this study that there does exist an association between acetaminophen over-dose and quality of life among liver-failure patients. However, one thing I noticed about this article is that it failed to explain why the quality of life was worse in patients with acetaminophen-induced liver failure, as it did not establish a substantial cause-and-effect relationship. I would like to know why this is because the article did not address this issue. After properly ensuring that it is fine for the patient to take, I would still recommend acetaminophen as it is intended for the treatment of headaches, fevers, and pain. We as pharmacists must stress to our patients the potential risks of acetaminophen and be extra careful in our recommendations. One question I pose to my colleagues is: What are some effective ways we can bring to our patient’s attention the potential risks of Tylenol without scaring them?

 

Resources

1.) Johnson, Kimball. Liver Failure. Digestive Disorders Health Center http://www.webmd.com/digestive-disorders/digestive-diseases-liver-failure. Published July 11, 2012. Accessed November 5, 2013.

2.) Slack A, Wendon J. Acute liver failure. Clinical Medicine [serial online]. June 2011;11(3):254-258. Available from: Academic Search Complete, Ipswich, MA. Accessed November 29, 2013.

3.) Huckleberry Y, Rollins C. Analgesics. In: Krinsky D, ed. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. Washington DC: American Pharmacists Association; 67-72.

4.) Tylenol Safety: Is There Reason To Worry? Child Health Alert [serial online]. September 2006;24:1-2. Available from: Academic Search Complete, Ipswich, MA. Accessed November 5, 2013.

Can Diluted Bleach Reverse Skin Damage and Aging?

Sunday, December 1st, 2013

By Lauren Callahan, PharmD Student Cedarville University

You need not watch television long before an advertisement for an anti-aging product appears on the screen. Commercials boast of expensive creams, moisturizers, and other topical agents that can effectively reverse signs of aging. However, in a comprehensive review of all anti-aging compounds, it was concluded that these over-the-counter products alone will likely not produce the desired anti-aging effect. A dilemma is posed because the large market of users of anti-aging products are oftentimes unaware of this lacking evidence.1 However, there is hope for a cheap and evidence-based compound for anti-aging therapy: bleach.

On November 15th, The Huffington Post published an article entitled, “Study Suggests Bleach Can Reverse The Aging Process.” The article summarized research from Stanford University showing that diluted bleach may be used to treat skin aging and damage.  According to the study, exposure to 0.005% diluted bleach in mice blocked the expression of NFkB proteins that play a critical role in the inflammation process. Without the inflammatory process, there is increased cell proliferation, leading to younger-looking skin. The treatment also offers hope for those suffering from inflammatory skin conditions like eczema, radiation dermatitis, and diabetic ulcers. 2

There is high-quality data supporting these conclusions. The primary source, the research article from Stanford University, demonstrated the benefits of utilizing diluted bleach in mice. The mechanism of bleach (HOCl) was studied in mouse tissues and was found to inhibit NFkB signaling in keratinocytes. This inhibition decreased the amount of cytokines released, thereby inhibiting the recruitment of inflammatory immune cells. This was evidenced in the results as the bleach ultimately induced epidermal hyperplasia, increased cell proliferation, and reversed aging-associated genes.

With this evidence at hand, I do agree with the idea that bleach could offer a safe and effective way to prevent aging. After my own review of the research from Stanford University, it became apparent that the focus of the study was not simply anti-aging; it focused more upon the use of bleach for a variety of other skin disease states. 3 Even though The Huffington Post briefly mentioned these other skin problems, the title and focus of the article is misleading as it promotes anti-aging therapy alone.

The use of diluted bleach for any skin condition differs from the standard of care. For skin aging, self-care recommendations include the application of alpha or beta hydroxy acids two times daily. Current standards of self-care treatment for eczema basically include avoidance of the irritant and application of topical corticosteroids. 4 The possibility of 0.005% diluted bleach as a skin aging therapy does not change my self-care recommendations for anti-aging products and will not change them until further studies have demonstrated a safe and effective diluted bleach regimen in humans.  I would possibly allow my patients to use bleach treatment for atopic dermatitis (a form of eczema) colonized with a bacteria called Staphylococcus aureus under supervision from a doctor; diluted bleach has been tested in numerous studies, indicating its efficacy and safety in treatment of this condition. 5 Side effects that accompany bleach treatment include dry skin, rash, and nasal irritation.6 However, since diluted bleach has yet to be tested in humans for the indication of aging, the side effects may differ.Although the bleach therapy for atopic dermatitis colonized with Staphylococcus aureus works through the same NFkB inhibitor mechanism, I would remain hesitant to recommend this treatment for skin aging.

The glaringly obvious limitation of this article is that the bleach therapy has been tested in mice only. The bleach offers a theoretical solution to skin-aging and has yet to be proven in humans. Though I offer caution now, there may be a day in the near future in which my foremost recommendation for aging and inflammatory skin problems is diluted bleach. After all, diluted bleach treatment would be convenient, cost-effective, and evidence-based unlike the products on the market today.

With all of these desirable qualities, it may be difficult to dissuade a patient from experimentally utilizing bleach as an anti-aging treatment for skin. What would be your response to a patient that seeks counsel on bleach for anti-aging therapy? Would it be different if they were seeking to use bleach treatment for relief from an inflammatory skin condition?

 

References

1 Huang, C.K., & Miller, T.A. (2007). The truth about over-the-counter topical anti-aging products: a comprehensive review. Aesthetic Surgery Journal, 27(4), 402-412.

2 O’Connor, Lydia (2013). Study Suggests Bleach Can Reverse The Aging Process. The Huffington Post. Retrieved from: http://www.huffingtonpost.com/2013/11/15/bleach-skin-condition_n_4278058.html

3 Kim, S.K., Knox, S.J., Leung, T.H., Ning, S., Wang, J., & Zhang, L.F. (2013). Topical hypochlorite ameliorates NF-κB–mediated skin diseases in mice. The Journal of Clinical Investigation. doi:10.1172/JCI70895.

4 Berardi R.R., Kroon L.A., McDermott J.H. et al (2006). Handbook of nonprescription drugs, an interactive approach to self-care. APhA Publications.

5 Huang, J. T., Abrams, M., Tlougan, B., Rademaker, A., & Paller, A. S. (2009). Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics, 123(5), e808-e814.

6 Barnes, T. M., & Greive, K. A. (2013). Use of bleach baths for the treatment of infected atopic eczema. Australasian Journal of Dermatology.