Azithromycin for PID beats doxycycline on all counts

Outpatient treatment of patients with mild pelvic inflammatory disease, using 1g of azithromycin weekly for 2 weeks, combined with 250mg of ceftriaxone intramuscularly on the first day, is superior to the current recommended treatment with doxycycline plus ceftriaxone. Stength of recommendation (SOR) A: Single well-designed RCT

Another option for patients with liver disease

Consider prescribing rifaximin for patients with hepatic encephalopathy, not only as a treatment for acute episodes but also to prevent a recurrence. Stength of recommendation: A: Based on a high-quality randomized controlled trial (RCT)

Double-dose vitamin D lowers cancer risk in women over 55

Increasing the dose of vitamin D3 from the current standard of 400-600 IU per day to 1000 IU per day lowers future risk of cancer in women older than age 55 who do not get adequate vitamin D from sun exposure or diet. Stength of recommendation (SOR):A Well done randomized controlled trial

Acute gout: Oral steroids work as well as NSAIDs

Use a short course of oral steroids (prednisone 30-40mg/d for 5 days) for treatment of acute gout when nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated. Steroids are also a reasonable choice as first-line treatment. Stength of recommendation: B: 2 good-quality, randomized controlled trials (RCTs)

This obscure herb works for the common cold

Offer patients Pelargonium sidoides (30 drops 3 times a day) to reduce the severity and duration of common cold symptoms and to get patients back to work sooner. Stength of recommendation: B: A single well-designed randomized controlled trial

Should we change formula for a formula-fed infant with persistent spitting up, but with adequate weight gain?

We found no controlled trials evaluating the efficacy of changing formulas in the management of uncomplicated regurgitation. However, the evidence suggests that no benefit can be expected from changing formulas, including the discontinuation of iron-fortified formulas. Additionally, changing formulas leads many mothers to believe that their child has a disease or illness. Although controlled trials of infants with gastroesophageal reflux disease (GERD) show that formula thickening (eg, with rice cereal) decreases spitting-up, and expert consensus panels recommend formula thickening (along with parental reassurance) as first-line therapy in the management of uncomplicated regurgitaion, one could question whether these outcomes in infants with GERD would hold for infants with uncomplicated regurgitation. Flat-prone positioning and avoiding the seated position is beneficial in infants with GERD, but the association of prone positioning with sudden infant death syndrome limits this intervention. (Grade of recommendation: D, based on a synthesis of information from controlled trials performed in other patient populations, retrospective surveys, physiologic evidence, and consensus expert opinion.

Let them eat nuts -- this snack is safe for diverticulosis patients

Tell patients with diverticular disease that they can eat nuts, corn, and popcorn without fear. There is no truth to the long-held belief that these foods increase the risk of complications. Strength of recommendatin: B: A large cohort study

Use anesthetic drops to relieve acute otitis media pain

Use 3 drops of topical 2% lidocaine drops or benzocaine to provide rapid pain relief for children with acute otitis media. Stength of recommendation: B: 2 good-quality, randomized controlled trials

Dust mite control measures don't help asthma patients

Stop recommending dust mite control measures to your asthma patients. Neither chemical nor physical reduction measures are effective in improving peak flow, symptoms of asthma, or medication usage. Stength of recommendation: B: Based on a meta-analysis of 54 fair quality randomized trials in patients with mite-sensitive asthma

Arthroscopic surgery for knee osteoarthritis? Just say no

Do not recommend arthroscopic surgery to adults with osteoarthritis of the knee. Treat knee pain with medical and physical therapy instead. Stength of recommendation: A: Based on 2 high-quality randomized controlled trials