Practice Changers: Updates in Family Medicine: 2015

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Περιληπτικά τα πιο σημαντικά κατ' εμέ:

1. Neuraminidase inhibitors are not indicated for the general population; they should be used only in patients with both a high likelihood of having the flu and who have such comorbid conditions as chronic obstructive pulmonary disease (COPD) or cardiovascular disease. Early initiation of treatment (within 48 hours of symptom onset), compared with late initiation, was found to significantly reduce severe outcomes.

2. Antibiotics According to a cohort study of US veterans treated with amoxicillin, azithromycin, or levofloxacin for 10 days patients receiving azithromycin had significantly increased risk for death and serious arrhythmia compared with patients receiving amoxicillin on days 1-5 of treatment. Patients receiving levofloxacin also had a statistically significant increased risk for both death and serious cardiac arrhythmia during the 10 days of treatment.
According to another study the use of clarithromycin for more than 7 days was associated with an elevated risk for cardiovascular events in patients with COPD.
Α Cochrane review that azithromycin offered no benefit over amoxicillin or amoxicillin/clavulanic acid for the treatment of acute lower respiratory tract infection

3. Apples vs statins According to a modeling study the anticipated reduction in annual deaths in the United Kingdom with statin therapy (assuming 70% adherence and a reduction in vascular mortality of 12%) would be approximately 9400; the reduction estimated with a daily apple intake was 8500. Although apple therapy might be slightly less efficacious, it would not be anticipated to cause any adverse effects.

4. Screening in kids The AAP schedule recommends screening all children for dyslipidemia at age 9-11 years and again at 17-21 years and for anemia at ages 15 and 30 months.

5. Viral symptoms last longer than we think For 90% of the children:
Croup resolved in 2 days;

Sore throat resolved in 2-7 days;

Earaches resolved in 7-8 days;

Common upper respiratory tract infection resolved within 15 days;

Nonspecific upper respiratory tract infection symptoms resolved within 16 days;

Bronchiolitis resolved within 21 days; and

Acute cough resolved within 25 days.

The bottom line is that no antibiotics are needed, and viral syndromes are best treated with patience and symptom control.