Less Is More

Simpler & Better Medicine

Penicillin for 5 or 10 days for Group A streptococcal pharnygitis. — December 31, 2019

Penicillin for 5 or 10 days for Group A streptococcal pharnygitis.

Summary: For patients over age 6 years with group A streptococcal pharnygitis meeting at least 3 of the Centor Criteria, treatment with Penicillin V 800 mg 4x daily for 5 days may be associated with a slightly shorter time to relief of symptoms and a lower likelihood of adverse events such as diarrhea, nausea, and vulvovaginal symptoms compared to treatment with Penicillin V 1000 mg 3x daily for 10 days; both approaches may be associated with the same likelihood (~ 90%) of clinical cure after 5-7 days.

https://www.ncbi.nlm.nih.gov/m/pubmed/31585944/

Strength of Recommendation = A

N95 Respirators or Medical Masks for Preventing Influenza Among Health Care Personnel. — November 26, 2019

N95 Respirators or Medical Masks for Preventing Influenza Among Health Care Personnel.

Summary: For health care personnel working near patients during the peak season for viral respiratory illnesses use of routine medical masks may be associated with the same risk of developing laboratory confirmed influenza, acute respiratory illness, or influenza-like illness as use of N95 respirators; while standard medical masks are both simpler to use and less costly than N95 respirators.

https://www.ncbi.nlm.nih.gov/m/pubmed/31479137/

Strength of Recommendation = B

N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel. — September 24, 2019

N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel.

Summary: For health-care professionals (HCPs) working in outpatient settings during the peak of viral respiratory season, use of standard medical masks when near patients with respiratory illnesses may be associated with the same risk of developing a laboratory-confirmed influenza infection (~ 7-8%) and the same risk of developing an influenza-like illness (~ 5-8%) as is use of a N95 respirator; while standard medical masks are both simpler to use and less costly than N95 respirators.

https://www.ncbi.nlm.nih.gov/m/pubmed/31479137/

Strength of Recommendation = B

Narrow- vs Broad-Spectrum Antibiotics for Children With Acute Respiratory Tract Infections — December 19, 2017

Narrow- vs Broad-Spectrum Antibiotics for Children With Acute Respiratory Tract Infections

Summary: For children with acute respiratory infections (eg, otitis media, acute sinusitis, or group A streptococcal pharyngitis) treatment with narrow-spectrum antibiotics (eg, penicillin or amoxicillin) may be associated with the same risk of treatment failure at 30 days (approximately 8%) as broad-spectrum antibiotics (amoxicillin-clavulanate, cephalosporins, or macrolides), however broad-spectrum antibiotics may be associated with a higher risk of adverse events requiring clinical care (NNH = 100) and a higher risk of patient-reported adverse events (NNH = 10).

https://www.ncbi.nlm.nih.gov/m/pubmed/29260224/

Strength of Recommendation = B

Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin for Uncomplicated Cellulitis — November 7, 2017

Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin for Uncomplicated Cellulitis

Summary: For patients with uncomplicated cellulitis (no wound, no abscess, no purulent drainage), treatment with cephalexin for 7 days may provide the same rates of clinical cure as treatment with cephalexin + trimethoprim -sulfamethoxazole for 7 days; but with a simpler antibiotic regimen.

https://www.ncbi.nlm.nih.gov/m/pubmed/28535235/

Strength of Recommendation = B

Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children. — October 10, 2017

Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children.

Summary: For patients under 21 years of age suspected to have community-acquired pneumonia (CAP), use of lung ultrasound for diagnostic testing may decrease the number of chest x-rays needed, thereby minimizing radiation exposure and reducing cost (absolute risk reduction 38.8% [95% CI, 30.0%-48.9%]), without any increased risk of missed cases of CAP.

https://www.ncbi.nlm.nih.gov/m/pubmed/26923626/

Strength of Recommendation = B

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
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