ABSTRACT
BENZODIAZEPINES REMAIN THE FIRST-LINE REGIMEN FOR ALCOHOL WITHDRAWAL SYNDROME (AWS) AND ARE THE ONLY CLASS MORE EFFECTIVE THAN PLACEBO FOR REDUCING SEIZURE (STRENGTH OF RECOMMENDATION [SOR]: B, BASED ON 3 MEDIUM-QUALITY RANDOMIZED CONTROLLED TRIALS [RCTS]). ANTICONVULSANTS ARE NO MORE EFFECTIVE THAN PLACEBO AT REDUCING SEIZURES (SOR: B, BASED ON 10 MODERATE-QUALITY RCTS). GABAPENTIN REDUCES WITHDRAWAL SYMPTOMS AND IS LESS SEDATING THAN BENZODIAZEPINES (SOR: B, BASED ON 1 MEDIUM-QUALITY RCT). CARBAMAZEPINE ALSO REDUCES WITHDRAWAL SYMPTOMS (SOR: B, BASED ON 3 RCTS). EVIDENCE OF BENZODIAZEPINE SUPERIORITY TO OTHER DRUGS WITH RESPECT TO SAFETY IS LACKING (SOR: A, BASED ON A META-ANALYSIS).
Subject(s)
Alcoholism/drug therapy , Substance Withdrawal Syndrome/drug therapy , Anticonvulsants/therapeutic use , Benzodiazepines/therapeutic use , Carbamazepine/therapeutic use , Gabapentin/therapeutic use , Humans , Systematic Reviews as TopicSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Antifibrinolytic Agents/therapeutic use , Contraceptive Agents, Hormonal/therapeutic use , Danazol/therapeutic use , Estrogen Antagonists/therapeutic use , Levonorgestrel/therapeutic use , Menorrhagia/drug therapy , Tranexamic Acid/therapeutic use , Adolescent , Adult , Female , Humans , Young AdultSubject(s)
Biological Products/therapeutic use , Blood Pressure/drug effects , Dietary Supplements , Hypertension/drug therapy , Hypertension/prevention & control , Adult , Aged , Aged, 80 and over , Arginine/therapeutic use , Beta vulgaris , Chocolate , Fatty Acids, Omega-3/therapeutic use , Female , Garlic , Humans , Linseed Oil/therapeutic use , Male , Middle Aged , OleaSubject(s)
Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Stroke/prevention & control , Vitamin K/antagonists & inhibitors , Warfarin/therapeutic use , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Aspirin/therapeutic use , Fibrinolytic Agents/therapeutic use , Hemorrhage/chemically induced , Humans , Meta-Analysis as Topic , Randomized Controlled Trials as Topic , Risk Factors , Stroke/etiology , Warfarin/adverse effectsSubject(s)
Anticoagulants/therapeutic use , Atrial Appendage/surgery , Atrial Fibrillation/surgery , Platelet Aggregation Inhibitors/therapeutic use , Stroke/prevention & control , Administration, Oral , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Drug Administration Schedule , Evidence-Based Medicine , Humans , Stroke/epidemiology , Stroke/etiology , Treatment OutcomeABSTRACT
Yes. Cognitive behavioral therapy (CBT) administered individually, in a group setting, or on the internet is effective for treating insomnia in adults compared with control (strength of recommendation [SOR]: A, meta-analyses). CBT is comparable to pharmacotherapy for improving measures of sleep (SOR: A, comparative meta-analysis). CBT produces sustainable improvements in subjective sleep quality for adults with comorbid insomnia (SOR: A, meta-analysis).
Subject(s)
Benzodiazepines/therapeutic use , Cognitive Behavioral Therapy/methods , Sleep Initiation and Maintenance Disorders/drug therapy , Sleep Initiation and Maintenance Disorders/therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Yes for exacerbations, no for hospitalizations. Prophylactic azithro-mycin reduces the number of exacerbations by about 25%. It also extends the time between exacerbations by approximately 90 days for patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). Azithromycin benefits patients who are >65 years, patients with Global Initiative for Obstructive Lung Disease (GOLD) stage II or III COPD, former smokers, and patients using long-term oxygen; it doesn't benefit patients ≤65 years, patients with GOLD stage IV COPD, current smokers, or patients not using oxygen (strength of recommendation [SOR]: B, randomized controlled trials [RCTs]). Prophylactic azithromycin doesn't reduce hospitalizations overall (SOR: B, single small RCT).
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis/methods , Erythromycin/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Adult , Age Factors , Aged , Aged, 80 and over , Azithromycin/therapeutic use , Female , Humans , Male , Middle AgedABSTRACT
No. Exercise doesn't decrease the frequency or severity of vasomotor menopausal symptoms in perimenopausal and postmenopausal women (strength of recommendation: A, systematic review of randomized controlled trials [RCTs] and consistent RCT).
Subject(s)
Exercise Therapy , Hot Flashes/prevention & control , Menopause , Sweating , Aged , Antidepressive Agents, Second-Generation/therapeutic use , Citalopram/therapeutic use , Estrogen Replacement Therapy , Fatty Acids, Omega-3/therapeutic use , Female , Humans , Middle Aged , Venlafaxine Hydrochloride/therapeutic use , YogaABSTRACT
No. Megestrol acetate (MA) is neither safe nor effective for stimulating appetite in malnourished nursing home residents. It increases the risk of deep vein thrombosis (strength of recommendation [SOR]: C, 2 retrospective chart reviews), but isn't associated with other new or worsening events or disorders (SOR: B, single randomized controlled trial [RCT]). Over a 25-week period, MA wasn't associated with increased mortality (SOR: B, single RCT). After 44 months, however, MA-treated patients showed decreased median survival (SOR: B, single case-control study). Consistent, meaningful weight gain was not observed with MA treatment (SOR: B, single case-control study, single RCT, 2 retrospective chart reviews, single prospective case-series).
Subject(s)
Appetite Stimulants/adverse effects , Malnutrition/drug therapy , Megestrol Acetate/adverse effects , Nursing Homes , Humans , Risk Factors , Venous Thrombosis/chemically inducedABSTRACT
EVIDENCE-BASED ANSWER: Topical permethrin is the most effective treatment for classic scabies (strength of recommendation [SOR]: A, meta-analyses with consistent results). Topical lindane and crotamiton are inferior to permethrin but appear equivalent to each other and benzyl benzoate, sulfur, and natural synergized pyrethrins (SOR: B, limited randomized trials). Although not as effective as topical permethrin, oral ivermectin is an effective treatment compared with placebo (SOR: B, a single small randomized trial). Oral ivermectin may reduce the prevalence of scabies at one year in populations with endemic disease more than topical permethrin (SOR: B, a single randomized trial).
Subject(s)
Antiparasitic Agents/therapeutic use , Benzoates/therapeutic use , Hexachlorocyclohexane/therapeutic use , Insecticides/therapeutic use , Scabies/drug therapy , Administration, Oral , Administration, Topical , Animals , Humans , Sarcoptes scabiei/drug effects , Sulfur/therapeutic use , Toluidines/therapeutic useABSTRACT
Yes for angiotensin-converting enzyme (ACE) inhibitors, no for angiotensin receptor blockers (ARBs). A 2011 meta-analysis of 5 RCTs (total 2975 patients) that compared ACE inhibitor therapy with placebo in diabetic patients without hypertension and albuminuria found that ACE inhibitors reduced the risk of new-onset microalbuminuria or macroalbuminuria by 18% (relative risk [RR]=0.82; 95% confidence interval [CI], 0.73-0.92).