Marc R. Via, MD

It is reasonable to try a 3-day course of azithromycin (Zithromax) 500 mg/d for patients with a firm diagnosis of acute bacterial sinusitis.

However, keep in mind that antibiotics in general do not provide a clinically meaningful advantage when compared with placebo. Azithromycin is well tolerated, and patients are more likely to complete a 3-day course than a 10-day one. Recall that amoxicillin is as effective as macrolides clinically, and that most cases of sinusitis are not bacterial.

It is reasonable to try a 3-day course of azithromycin (Zithromax) 500 mg/d for patients with a firm diagnosis of acute bacterial sinusitis.

However, keep in mind that antibiotics in general do not provide a clinically meaningful advantage when compared with placebo. Azithromycin is well tolerated, and patients are more likely to complete a 3-day course than a 10-day one. Recall that amoxicillin is as effective as macrolides clinically, and that most cases of sinusitis are not bacterial.

It is reasonable to try a 3-day course of azithromycin (Zithromax) 500 mg/d for patients with a firm diagnosis of acute bacterial sinusitis.

However, keep in mind that antibiotics in general do not provide a clinically meaningful advantage when compared with placebo. Azithromycin is well tolerated, and patients are more likely to complete a 3-day course than a 10-day one. Recall that amoxicillin is as effective as macrolides clinically, and that most cases of sinusitis are not bacterial.

It is reasonable to consider screening for excessive alcohol consumption if time and circumstances permit, realizing the ultimate benefit will be extremely small.

Overall, if a practitioner screens 1000 patients, carries out further assessment in 90 (9%) who screen positive, and gives feedback, information, and advice to the 25 (2.5%) who qualify for brief intervention, 2 or 3 patients can be expected to have reduced their alcohol consumption to below recommended maximum levels after 12 months. This results in a number needed to screen with outcome measured at 1 year (NNS₁) of 500. To put this in perspective, the NNS₅ (to prevent 1 death in 5 years) for dyslipidemia is 418; for hypertension, 274–1307; for hemoccult testing, 1374; for mammography in those aged 50–59 years, 2451.

It is reasonable to consider screening for excessive alcohol consumption if time and circumstances permit, realizing the ultimate benefit will be extremely small.

Overall, if a practitioner screens 1000 patients, carries out further assessment in 90 (9%) who screen positive, and gives feedback, information, and advice to the 25 (2.5%) who qualify for brief intervention, 2 or 3 patients can be expected to have reduced their alcohol consumption to below recommended maximum levels after 12 months. This results in a number needed to screen with outcome measured at 1 year (NNS₁) of 500. To put this in perspective, the NNS₅ (to prevent 1 death in 5 years) for dyslipidemia is 418; for hypertension, 274–1307; for hemoccult testing, 1374; for mammography in those aged 50–59 years, 2451.

It is reasonable to consider screening for excessive alcohol consumption if time and circumstances permit, realizing the ultimate benefit will be extremely small.

Overall, if a practitioner screens 1000 patients, carries out further assessment in 90 (9%) who screen positive, and gives feedback, information, and advice to the 25 (2.5%) who qualify for brief intervention, 2 or 3 patients can be expected to have reduced their alcohol consumption to below recommended maximum levels after 12 months. This results in a number needed to screen with outcome measured at 1 year (NNS₁) of 500. To put this in perspective, the NNS₅ (to prevent 1 death in 5 years) for dyslipidemia is 418; for hypertension, 274–1307; for hemoccult testing, 1374; for mammography in those aged 50–59 years, 2451.

In children with acute pharyngitis, oral dexamethasone does not provide clinically significant reductions in time to initial or complete pain relief. Reserve its use for children with group A -hemolytic streptococcus pharyngitis who have moderate to severe pain, realizing that the benefit is of questionable significance.

In children with acute pharyngitis, oral dexamethasone does not provide clinically significant reductions in time to initial or complete pain relief. Reserve its use for children with group A -hemolytic streptococcus pharyngitis who have moderate to severe pain, realizing that the benefit is of questionable significance.

In children with acute pharyngitis, oral dexamethasone does not provide clinically significant reductions in time to initial or complete pain relief. Reserve its use for children with group A -hemolytic streptococcus pharyngitis who have moderate to severe pain, realizing that the benefit is of questionable significance.

Diclofenac 150 mg/d is more effective in controlling osteoarthritis symptoms than acetaminophen 4 g/d in patients previously requiring an nonsteroidal anti-inflammatory drug (NSAID).

Since acetaminophen is less expensive and better tolerated, it is reasonable to attempt a 2-week trial in all patients prior to initiating treatment with NSAIDs.

Diclofenac 150 mg/d is more effective in controlling osteoarthritis symptoms than acetaminophen 4 g/d in patients previously requiring an nonsteroidal anti-inflammatory drug (NSAID).

Since acetaminophen is less expensive and better tolerated, it is reasonable to attempt a 2-week trial in all patients prior to initiating treatment with NSAIDs.

Diclofenac 150 mg/d is more effective in controlling osteoarthritis symptoms than acetaminophen 4 g/d in patients previously requiring an nonsteroidal anti-inflammatory drug (NSAID).

Since acetaminophen is less expensive and better tolerated, it is reasonable to attempt a 2-week trial in all patients prior to initiating treatment with NSAIDs.

Hand lacerations less than 2 cm long without tendon, joint, fracture, or nerve complications and not involving the nail bed can be cleaned and dressed without suturing, with similar cosmetic results and time to resume normal activities. Moreover, managing these uncomplicated hand lacerations conservatively could result in better use of medical resources and improved patient satisfaction due to less pain and less time spent in the emergency department.

Hand lacerations less than 2 cm long without tendon, joint, fracture, or nerve complications and not involving the nail bed can be cleaned and dressed without suturing, with similar cosmetic results and time to resume normal activities. Moreover, managing these uncomplicated hand lacerations conservatively could result in better use of medical resources and improved patient satisfaction due to less pain and less time spent in the emergency department.

Hand lacerations less than 2 cm long without tendon, joint, fracture, or nerve complications and not involving the nail bed can be cleaned and dressed without suturing, with similar cosmetic results and time to resume normal activities. Moreover, managing these uncomplicated hand lacerations conservatively could result in better use of medical resources and improved patient satisfaction due to less pain and less time spent in the emergency department.