Less Is More

Simpler & Better Medicine

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis. — November 15, 2016

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis.

Summary: For adult patients with severe sepsis (but not in septic shock), an approach of not administering glucocorticoids may be associated with the same risks of developing septic shock and of in-hospital or 28-day mortality as an approach of routinely administering a continuous infusion of hydrocortisone for 5 days, but avoiding routine use of glucocorticoids may be associated with a lower risk of hyperglycemia.

https://www.ncbi.nlm.nih.gov/m/pubmed/27695824/

Strength of Recommendation = B

Duration of Antibiotic Treatment in Community-Acquired Pneumonia. — September 27, 2016

Duration of Antibiotic Treatment in Community-Acquired Pneumonia.

Summary: For adult patients hospitalized with community-acquired pneumonia (CAP), a practice of stopping antibiotics after 5 days’ treatment if the patient has been afebrile for 48 hours and has no more than one sign of clinical instability*, appears to be associated with a shorter overall duration of antibiotic treatment and a lower likelihood of hospital re-admission over the next 30 days (with no worse rates of clinical improvement or symptom improvement) compared to a practice of stopping antibiotics based on the clinical determination or impression of the treating physician.

* – Signs of clinical instability in CAP: Systolic blood pressure  < 90 mm Hg, heart rate >  100/min, respiratory rate > 24 /min,  oxygen saturation < 90%, or Pao2 < 60 mm Hg on room air.

http://www.ncbi.nlm.nih.gov/m/pubmed/27455166/

Strength of Recommendation = B

Clinically-indicated replacement versus routine replacement of peripheral venous catheters. — August 19, 2016

Clinically-indicated replacement versus routine replacement of peripheral venous catheters.

Summary: For hospitalized patients with peripheral intravenous (IV) catheters, a practice of waiting until clinically indicated to replace the IV catheter appears to be associated with the same risk of catheter-related bloodstream infection, local thrombophlebitis, or all-cause bloodstream infection, compared to a practice of routine IV catheter replacement every 72 to 96 hours.

http://www.ncbi.nlm.nih.gov/m/pubmed/26272489/

Strength of Recommendation = A

Chest radiographs for acute lower respiratory tract infections. — July 1, 2016

Chest radiographs for acute lower respiratory tract infections.

Summary: For patients (adults or children) presenting with a possible lower respiratory tract infection, management without the use of chest radiography may lead to the same duration of illness and of symptoms as management based on chest radiography findings, but at lower cost and without radiation exposure.

http://www.ncbi.nlm.nih.gov/m/pubmed/24369343/

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

Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease. — April 5, 2016
%d bloggers like this: