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Although the marketing and labeling of bevacizumab have not been approved by the US Food and Drug Administration for the treatment of macular edema due to central retinal vein occlusion, bevacizumab is often prescribed for this condition because it is safe and effective for other retinal diseases and is less expensive than aflibercept. To learn whether bevacizumab and aflibercept have similar efficacy, Scott and colleagues conducted a randomized clinical trial of 362 patients with macular edema due to central retinal or hemiretinal vein occlusion and demonstrated that bevacizumab was noninferior to aflibercept for the outcome of visual acuity. In an Editorial, Bressler cautions that more information is needed before bevacizumab can be recommended for the treatment of macular edema secondary to a central retinal or hemiretinal vein occlusion.
For patients who have nonpurulent cellulitis without an abscess, guidelines recommend an antibiotic such as cephalexin that has activity against streptococci, but in practice patients with cellulitis may also receive an antibiotic such as trimethoprim-sulfamethoxazole that has activity against methicillin-resistant Staphylococcus aureus (MRSA). In a randomized clinical trial, Moran and colleagues randomized 500 patients with cellulitis to receive cephalexin plus placebo or cephalexin plus trimethoprim-sulfamethoxazole for 7 days. The findings of this trial raise the possibility that the 2-drug combination may be superior to cephalexin alone. However, in an Editorial, Shuman and Malani conclude that most patients presenting with nonpurulent cellulitis without an abscess can be safely treated without the addition of antimicrobials directed against MRSA.
Editorial and JAMA Patient Page
Patients with gastric cancer who undergo gastrectomy are at risk for acute isovolemic anemia because of their decreased ability to absorb iron. In a randomized clinical trial by Kim and colleagues of 454 patients with acute isovolemic anemia after gastrectomy for gastric cancer, those who received an infusion of ferric carboxymaltose were more likely than those who received saline placebo to have an improved hemoglobin response at 12 weeks.
Academic medical centers are considered to be more expensive than community hospitals, but the value of medical care is a function of quality as well as cost. Burke and colleagues examined risk-adjusted outcomes for Medicare patients admitted to teaching vs nonteaching hospitals across a broad range of medical and surgical conditions and found that mortality rates were lower in major teaching hospitals.
Depression is common in later life. Kok and Reynolds discuss the clinical management of older adults with depressive symptoms and the risk of adverse drug reactions for patients receiving multiple medications.
Alternatives to the traditional fee-for-service model have been proposed to control costs and improve the quality of care for patients with cancer. An article in JAMA Oncology compared a bundled-payment pay-for-performance program with a fee-for-service program for patients with breast cancer in Taiwan; the pay-for-performance program was associated with better adherence to quality indicators, better health outcomes, and more effective cost-control. In this From The JAMA Network article, Basch suggests that better adherence in the pay-for-performance program may be attributable to coordination of care and early interventions for adverse events before they lead to hospitalizations.
This JAMA Clinical Challenge article by Shiiya and Ota presents a newborn infant with fever, anemia, and erythematous plaques on his forehead and periorbital areas. What would you do next?
Highlights. JAMA. 2017;317(20):2033–2035. doi:10.1001/jama.2016.13141
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