RSV is a scary pneumonia. It hits infants, often within a couple of weeks of delivery. They look sick. They wheeze. Their chests bend in with their effort. I have spent 33 years being petrified of these kids because there isn’t much you can do for them except put them on a ventilator. And their mothers are living in sheer terror. Every child gets it by age two, but most hardly know it other than a bad cold. But we still have a couple of hundred thousand admissions to the hospital every year for newborns whose little chests are almost collapsing with their effort to breathe. “It’s just bronchiolitis from RSV”, we say, and shrug our shoulders.

Well! No longer. This article shows you can cut RSV some 85% if you take Vitamin D supplementation during pregnancy. The researchers in this study took 156 neonates and measured their cord blood PROSPECTIVELY for vitamin D. (That’s as close as you can get to a randomized controlled trial.) They they waited to see who got sick. What they found was a very strong association between the D level in the cord blood and mother taking a D supplement, AND the child then getting RSV or not. The authors suggest that the recommended level of 600 IU for pregnancy women is woefully inadequate. In fact, this column has reviewed Drs Hollis and Wagner’s work from S. Carolina where they showed it takes about 4000 IU a day to have a baby born with a Vit D level in the 50 ng range. A mother’s blood level strongly correlates with the baby’s blood level. Fifty ng is what you get when you have adequate sunshine year around, and work outdoors, and don’t wear clothes. Sort of like what we did prior to 10,000 years ago.

How does D do all that? We’ve learned about D and bones until we can rote recite it. What folks don’t hear is that fundamentally Vitamin D makes your stem cells turn into mature cells and do their function properly. We humans have at least 3000 different kinds of cells, and each starts as a stem cell. To mature, we need D. That works in bones as well as white cells. Mature while cells can kill viruses. Our reviewed study from Japan last year showed that D doubled the effectiveness of a flu shot in children. Flu is another deadly virus. So, D is working by stimulating the stem cells for those lymphocytes that kill viruses. Magic!

And what did our recent national guidelines come out saying? 600 IU a day is enough! That’s enough for BONE HEALTH only. It’s not sufficient to get to 30 ng reliably and 30 ng is the threshold where we know Vit D stimulates the production of cathelicidin, your bodies natural antibiotic. To get to 30 reliably, you need 3000 IU a day. To get to 50 reliably, you need 5000 IU a day.

What I find most unique is that many researchers in D are taking 5000 IU a day. And we keep wringing our hands about how to prevent early infant mortality, particularly in Milwaukee, the city with the highest level in the country. Our newspaper is running Sunday front page featured articles about reducing early childhood deaths. And now we have a paper to show us how to reduce one of the most common infant pneumonia. Hopefully our editors and community organizers will read this paper. Or perhaps you can forward it to them.

WWW. What will work for me. It’s time to call for community action for higher D level supplementation for pregnant women. Hollis and Wagner first showed us the way. Now we have Belderbos and Heuben. Every pregnant woman I know hears it from me. Help me out here. Spread the word. Every pregnant woman you know! A pregnancy lasts 9 months. You can buy enough D for that time for $ 8 as Sam’s Club. People ask me if I’m worried about the liability in OB. I believe the weight of liability has shifted to those who knowingly don’t check and provide D for pregnant women.

Reference: http://pediatrics.aappublications.org/content/early/2011/05/05/peds.2010-3054.abstract

Also, my husband and I were thinking about his prescription for Altoprev, a statin to reduce cholesterol. He has developed terrible pains in his hip and leg, making sleep difficult at night. He hypothesised that it might be a side-effect of Altoprev. He checked, saw that muscle pain was one and stopped the drug. So far, the pain is going away. – Sharon Genasci, via e-mail

WDDTY replies: Your husband has done himself a favour. Statins have been used to lower cholesterol since they were first introduced in the 1980s, and they come with a long list of side-effects. The muscle pain your husband suffered is a common complaint, and numerous WDDTY readers taking statins have written to us about it.

There are a number of natural alternatives to help lower cholesterol. For example, traditional Chinese medicine advocates red yeast rice to revitalise energy and increase blood flow. Herbal medicine supports the use of fenugreek, alfalfa or guar gum to reduce cardiovascular risk. For more detailed information, read Dr Harald Gaier’s article on alternative treatments for high cholesterol (WDDTY vol 14 no 9).

Regarding drugs and pneumonia, the article revealed how commonly prescribed medications, including heart drugs, can lead to pneumonia. As for your query about the possibility of a reverse scenario (pneumonia drugs leading to heart disease), bacterial pneumonia is often treated with antibiotics and, while adverse effects are reported, heart disease is not among them. However, this doesn’t mean it can’t occur. If the patient is taking antibiotics together with other medications, the drug interactions could lead to serious side-effects that could include heart attack and stroke.

Specifically, this includes suicide, depression (in nearly a third of patients), aggressive behaviour, hallucinations, bipolar disorders and mania.

Otherwise, the drug may lead to a severe decrease in white blood cells and blood platelets, and may cause diabetes, low blood pressure, irregular heartbeats, angina and even a heart attack. Then there’s pneumonia and respiratory failure, colitis, pancreatitis, autoimmune disorders, loss of vision and retinopathy. And that’s just the one drug.

As for ribavirin (Rebetol is a Schering product), this can cause birth defects or death of an unborn child if you take it when pregnant. Some 10 per cent of those taking ribavirin develop haemolytic anaemia. In combination with PEG-Intron, it can cause blood, endocrine and liver abnormalities.

On its website FAQs For Patients, Schering cheerily notes: ‘Certain symptoms like severe stomach pain may mean that your internal organs are being damaged.’

All this and very little assurance that it works. According to Schering, only 24 per cent of patients respond to PEG-Intron, and far less if you are a particular viral genotype.

In the first, Spanish researchers randomised 587 HIV patients receiving PCP prophylaxis to either continue or discontinue treatment.

Of 474 patients receiving primary prophylaxis, 240 patients discontinued and experienced no PCP episodes after a median follow up period of 20 months. Of 113 patients receiving drugs to prevent a second infection, 60 patients stopped and had no PCP episodes after a median follow up period of 12 months.

In a second study, Swiss researchers assessed the incidence of recurrent PCP in 325 HIV patients who stopped secondary prophylaxis after achieving a CD4 cell count of more than 200 cells/mL while receiving at least three antiretroviral drugs. As with the Spanish results, the Swiss team found no cases of recurrence of PCP at a median of 13 months after discontinuation of the drugs.

These results suggest that if the response to antiretroviral therapy is good, just in case preventative drugs can be discontinued even in patients who have had previous P. carinii pneumonia (N Engl J Med, 2001; 344: 159-67, 168-73).

A Swedish study shows that middle aged and elderly patients vaccinated against pneumococcal pneumonia were not protected and were, in fact, more likely to come down with the disease.

The trial was carried out in hospitals across the country. Pneumococcal pneumonia was diagnosed in 4.5 per cent of the 352 patients in the placebo group and 5.6 per cent of the 339 patients among those given the vaccine.

This pattern was repeated in the number of patients who developed general pneumonia. In the vaccine group, as many as 19 per cent of patients developed a new pneumonia, while only 16 per cent of the placebo group contracted the new strain. There was no difference in the death rates of the two study groups.

The middle aged and elderly patients in the double blind, randomised, placebo controlled trial had been discharged from hospital after treatment for pneumonia, but were otherwise thought to be healthy. The vaccine was given eight weeks after hospital discharge (Lancet, 1998; 351: 398-403).

The CDC’s Active Bacterial Core Surveillance data from 1995-1999 from seven states revealed pneumococcal resistance to fluoroquinolones. Pneumococcal bacteria samples that were not susceptible to ofloxacin increased from 2.6 per cent in 1995 to 3.8 per cent in 1997. In both 1998 and 1999, 0.2 per cent of bacterial samples did not respond to the newer levofloxacin.

Samples not responding to ofloxacin were more common in those aged over 18 and, among these, increased from 3.1 per cent in 1995 to 4.5 per cent in 1997. Fluoroquinolone use is not licensed for those under 18. All of the samples not responding to levofloxacin were found in adults, with a prevalence that was only slightly increased, from 0.2 per cent in 1998 to 0.3 per cent in 1999.

Although pneumococci not susceptible to fluoroquinolones are now present in the US, it is unclear whether there is increased resistance. However, as stated in the editorial note, ‘trends in ofloxacin susceptibility may predict what will occur for other fluoroquinolone agents’.

Of the 15 samples not responding to levofloxacin, many also had decreased susceptibility to penicillin, trimethoprim-sulphamethoxazole, cefotaxime and/or erythromycin.

Fluoroquinolones are being increasingly prescribed and this may be contributing to the emergence of resistant pneumococci. Physicians are now urged to use these antibiotics – including ciprofloxacin and newer, more powerful ones such as grepafloxacin, gatifloxacin and moxifloxacin – more appropriately and judiciously (MMWR, 2001; 50: 800-4).

Some of these children were affected indirectly, because the mother had taken the drug when she was pregnant or while breastfeeding.

Nonetheless, it hardly needs stating that these figures are extraordinarily conservative, as statistics always seem to be when it comes to reporting drug side-effects and reactions.

Although 2,000 drugs, including vaccinations, were implicated, just 17 were responsible for more than half the serious side effects, and four were suspected in up to one-third of the deaths.

Some of the main culprits included antibiotics, over-the-counter medications such as ibuprofen, and treatments for respiratory syncytial virus (RSV), a common childhood infection that can lead to pneumonia.

These figures are at the heart of one of the fundamental problems about drug testing and licensing. Although the licensing process can cost a pharmaceutical company around £150m, the drug is never, if rarely, tested on the people who may eventually take it, such as pregnant women, the very young and the elderly. Instead, it’s a useful way for young medical students to supplement their income and, because they are strapping, healthy young things, they don’t suffer too many side-effects.

Give the same drug to an elderly person already on a cocktail of other drugs and the result may well be very different. But then, of course, if the drug company recruited the pensioner to the initial trials, the drug would probably never get a licence in the first place.

To understand the workings of the drugs industry, and why so many drugs go wrong, read Secrets of the Drug Industry, which you can buy from the WDDTY website http://www.wddty.co.uk/shop/details.asp?product=341

They have found that, in the six years until 2000, it declined from an 86 per cent effectiveness to just 76 per cent – and the researchers lay the blame squarely at the door at persistent antibiotic overuse.

Within the intensive care setting, the most common antibiotics are the fluoroquinolones, commonly prescribed for the treatment of urinary tract infections and pneumonia.

As with food infections, there are good herbal remedies to treat these problems – but we forgot, they’re banning them, aren’t they?

(Source: Journal of the American Medical Association, 2003; 289: 885-8).

This is because these drugs suppress gastric acids, thereby allowing viruses and bacteria in the upper gastrointestinal tract to migrate up into the respiratory tract.

In a study of 364,683 people, Dutch scientists found that 5551 of them had their first bout of pneumonia during the study period (from 1995 to 2002). After eliminating other factors, the researchers concluded that the risk of pneumonia was just 0.6 among those who had never taken an acid-suppressant compared with 2.45 for those who had taken at least one at some time during the study.

Their findings were similar for proton-pump inhibitors and H2 antagonists. The risk of developing pneumonia with an H2 antagonist was 1.63 and, with a proton-pump inhibitor, 1.89.

The research team, from Nijmegen, noted that pneumonia can be fatal among the elderly, who are more likely to regularly take an antacid for mild stomach disorders. As gastric-acid secretion is reduced in those over 60 anyway, they are already more liable to develop pneumonia, even without the help of antacids.

Antacids are thought to have no serious side-effects and, so, are freely available in pharmacies and supermarkets. Popular brands include Andrews, Bisodol, De Witt’s, Pepto-Bismol, Setlers and Tums. The few that contain magnesium are available only on prescription.

Any side-effects are considered mild. Those made with magnesium may have a laxative effect, while those with aluminium can cause constipation. Magnesium carbonate can also lead to belching.

Similarly, proton-pump inhibitors such as Losec (omeprazole), Nexium (esomeprazole) and Zoton (lansoprazole) are also regarded as benign, although they require a prescription. The most common side-effects are diarrhoea, nausea, constipation, flatulence, abdominal pain and headache.

H2 antagonists include some of the world’s most successful drugs, including Tagamet (cimetidine) and Zantac (ranitidine). These are used to treat stomach and duodenal ulcers, especially those due to NSAID (non-steroidal anti-inflammatory drug) painkillers. Also prescribed to relieve indigestion and heartburn, again they are believed to cause only minor side-effects such as diarrhoea, dizziness and headache. Tagamet is also associated with hair loss.

Doctors are already aware of restrictions on the use of acid-suppressants. Of the antacids, sodium bicarbonate shouldn’t be taken by people on a salt-restricted diet, aluminium-containing antacids should be avoided by those with low blood phosphate and those containing magnesium shouldn’t be taken by people with kidney problems. Proton-pump inhibitors and H2 antagonists should never be prescribed to people with liver or kidney problems, or to pregnant or breastfeeding women.

Now the Dutch researchers want a new set of further restrictions, and are urging doctors to think carefully before prescribing an antacid to elderly patients, particularly those who have a history of chronic respiratory problems, such as asthma or obstructive lung disease (JAMA, 2004; 292: 1955-60).