Less Is More

Simpler & Better Medicine

5-Day versus 10-Day Course of Fluoroquinolones in Outpatient Males with a Urinary Tract Infection (UTI). — December 2, 2016

5-Day versus 10-Day Course of Fluoroquinolones in Outpatient Males with a Urinary Tract Infection (UTI).

Summary: For males with a urinary tract infection, a 5-day course of levofloxacin (750 mg once daily) may provide the same likelihood of clinical treatment success as a 10 day course of ciprofloxacin (400 mg IV or 500 mg PO twice daily), and 5 day course of levofloxacin may provide a higher likelihood of clinical treatment success than a for 10 day course of ciprofloxacin for males with catheters, neurogenic bladder, or urinary retention.

https://www.ncbi.nlm.nih.gov/m/pubmed/28076247/

Strength of Recommendation = C

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10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. — October 7, 2016

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer.

Summary: For men between 50 and 69 years old with clinically localized prostate cancer detected by prostate-specific antigen (PSA) screening, active monitoring * appears to result in the same 10-year prostate-cancer-specific survival (~98%) and all-cause-mortality survival as either radiotherapy or prostatectomy.

 * – “Active monitoring” in this study consisted of frequent scheduled PSA levels, with a 50% increase in PSA value triggering clinical review and reassessment of management options; see full article for details.

http://www.ncbi.nlm.nih.gov/m/pubmed/27626136/

Strength of Recommendation = B

D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. — April 12, 2016

D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial.

Summary: For women with recurrent cystitis, taking D-mannose (2 g of D-mannose daily for 6 months) may be just as effective at preventing another episode of cystitis as taking nitrofurantoin (50 mg daily for 6 months) but with a lower risk of side effects (and potentially without the risk of inducing antibiotic resistance, although this was not directly addressed in this study).

http://www.ncbi.nlm.nih.gov/m/pubmed/23633128/

Strength of Recommendation = B

Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. — February 9, 2016

Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial.

Summary: For adult women with typical symptoms of a urinary tract infection (eg, dysuria, frequency, or urgency) and without any risk factors for complication (eg, fever, loin tenderness, pregnancy, kidney disease, or recent urinary infection or catheterization), treatment with ibuprofen 300 mg 3x daily for 3 days may provide the same likelihood of recovery as treatment with a single dose of fosfomycin, thus allowing treatment without the need for an antibiotic prescription (although women treated with ibuprofen may take about 1 day longer to achieve full remission of symptoms).

http://www.ncbi.nlm.nih.gov/m/pubmed/26698878/

Strength of Recommendation = B

Diagnostic accuracy of an initial azoospermic reading compared with results of post-centrifugation semen analysis after vasectomy. — July 27, 2015

Diagnostic accuracy of an initial azoospermic reading compared with results of post-centrifugation semen analysis after vasectomy.

Summary: For post-vasectomy semen analysis (PVSA), microscopic examination of a single uncentrifuged specimen at 10 weeks may be just as reliable, and technically easier, for identifying semen samples after vasectomy with more than 100,000 sperm per ml.

http://www.ncbi.nlm.nih.gov/m/pubmed/18804227/

Strength of Recommendation = B

A novel cost-effective approach to post-vasectomy semen analysis. — July 15, 2015

A novel cost-effective approach to post-vasectomy semen analysis.

Summary: For men who have had a vasectomy, a post-vasectomy semen analysis (PVSA) approach that uses demonstration of absence of sperm on simple light microscopy in a single specimen of semen at 16 or 20 weeks post-vasectomy in order to determine “surgical success” may reduce the costs of PVSA by up to 40%. (In this study, further viability testing was recommended for any patient with persistent non-motile sperm at 20 weeks).

http://www.ncbi.nlm.nih.gov/m/pubmed/21388491/

Strength of Recommendation = B

How little is enough? The evidence for post-vasectomy testing. — June 27, 2015

How little is enough? The evidence for post-vasectomy testing.

Summary: For post-vasectomy follow-up, a post-vasectomy semen analysis (PVSA) utilizing one specimen showing azoospermia after 3 months and 20 ejaculations may be just as reliable at assuring sterility as typical two-specimen protocols, but with fewer required follow up visits.

http://www.ncbi.nlm.nih.gov/m/pubmed/15947571

Strength of Recommendation  = B

Low-cost mesh for inguinal hernia repair in resource-limited settings. — June 23, 2015

Low-cost mesh for inguinal hernia repair in resource-limited settings.

Summary: For inguinal hernia repair in resource-limited settings, there may be no significant differences in surgical outcomes (eg, recurrence rates, incidence of wound infections) using sterilized mosquito netting or an indigenous bilayer device, compared to using commercial surgical mesh; and mosquito netting or a low-cost locally-manufactured device may be markedly less expensive.

http://www.ncbi.nlm.nih.gov/m/pubmed/21607572

Strength of Recommendation = B

The use of sterilized mosquito nets for hernioplasty: a systematic review. — June 11, 2015
Management of asymptomatic inguinal hernia: a systematic review of the evidence. — May 8, 2015

Management of asymptomatic inguinal hernia: a systematic review of the evidence.

Summary: For patients with asymptomatic inguinal hernia, there may be no difference in pain and discomfort, general health status, complications, or risk of life-threatening with “watchful waiting” compared to immediate surgery – both treatment options for asymptomatic inguinal hernia are safe, but most patients will develop symptoms (mainly pain) over time and will require operation.

http://www.ncbi.nlm.nih.gov/m/pubmed/22430913/

Strength of Recommendation = B

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