Q&A

The authors propose that moderate acne may be treated with doxycycline in subantimicrobial doses (20-mg tablets taken twice daily). This regimen was well-tolerated, moderately effective in reducing skin lesions, and did not have a detectable effect on the antibiotic resistance of skin flora.

The cost of Periostat (the only form of doxycycline 20 mg available in the US) is about $55 per month, while generic doxycycline 100 mg is about $10.¹ This study has some significant flaws, but a trial of low-dose doxycycline in an adult with acne severe enough to warrant antibiotics would still seem a reasonable, albeit expensive, option.

The authors propose that moderate acne may be treated with doxycycline in subantimicrobial doses (20-mg tablets taken twice daily). This regimen was well-tolerated, moderately effective in reducing skin lesions, and did not have a detectable effect on the antibiotic resistance of skin flora.

The cost of Periostat (the only form of doxycycline 20 mg available in the US) is about $55 per month, while generic doxycycline 100 mg is about $10.¹ This study has some significant flaws, but a trial of low-dose doxycycline in an adult with acne severe enough to warrant antibiotics would still seem a reasonable, albeit expensive, option.

The authors propose that moderate acne may be treated with doxycycline in subantimicrobial doses (20-mg tablets taken twice daily). This regimen was well-tolerated, moderately effective in reducing skin lesions, and did not have a detectable effect on the antibiotic resistance of skin flora.

The cost of Periostat (the only form of doxycycline 20 mg available in the US) is about $55 per month, while generic doxycycline 100 mg is about $10.¹ This study has some significant flaws, but a trial of low-dose doxycycline in an adult with acne severe enough to warrant antibiotics would still seem a reasonable, albeit expensive, option.

When added to antihypertensive treatment in patients with diabetes and nephropathy, neither the angiotensin receptor blocker (ARB) irbesartan nor the calcium channel blocker amlodipine reduced the overall occurrence of cardiovascular events. However, irbesartan decreased the rate of heart failure and amlodipine reduced the rate of acute myocardial infarction.

When added to antihypertensive treatment in patients with diabetes and nephropathy, neither the angiotensin receptor blocker (ARB) irbesartan nor the calcium channel blocker amlodipine reduced the overall occurrence of cardiovascular events. However, irbesartan decreased the rate of heart failure and amlodipine reduced the rate of acute myocardial infarction.

When added to antihypertensive treatment in patients with diabetes and nephropathy, neither the angiotensin receptor blocker (ARB) irbesartan nor the calcium channel blocker amlodipine reduced the overall occurrence of cardiovascular events. However, irbesartan decreased the rate of heart failure and amlodipine reduced the rate of acute myocardial infarction.

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.

Low-intensity warfarin (target international normalized ratio [INR], 1.5–2.0) effectively prevents recurrent venous thromboembolism without increasing the risk of major bleeding when used long-term for secondary prophylaxis. This is a reasonable approach following at least 3 to 12 months of full-intensity warfarin after the initial thromboembolic event.

Low-intensity warfarin (target international normalized ratio [INR], 1.5–2.0) effectively prevents recurrent venous thromboembolism without increasing the risk of major bleeding when used long-term for secondary prophylaxis. This is a reasonable approach following at least 3 to 12 months of full-intensity warfarin after the initial thromboembolic event.

Low-intensity warfarin (target international normalized ratio [INR], 1.5–2.0) effectively prevents recurrent venous thromboembolism without increasing the risk of major bleeding when used long-term for secondary prophylaxis. This is a reasonable approach following at least 3 to 12 months of full-intensity warfarin after the initial thromboembolic event.

Using oral clindamycin to treat women with asymptomatic bacterial vaginosis during their second trimester (between 12 and 22 weeks estimated gestational age) reduces the number of premature births and late miscarriages. The study did not demonstrate a difference in the number of neonatal intensive care unit admissions, mean birth weight, or gestational age.

This is the first study demonstrating benefits in treating asymptomatic bacterial vaginosis early in pregnancy. It still needs to be determined, in larger trials, whether generalized screening and treatment for asymptomatic bacterial vaginosis in the early second trimester is beneficial and cost-effective.

Using oral clindamycin to treat women with asymptomatic bacterial vaginosis during their second trimester (between 12 and 22 weeks estimated gestational age) reduces the number of premature births and late miscarriages. The study did not demonstrate a difference in the number of neonatal intensive care unit admissions, mean birth weight, or gestational age.

This is the first study demonstrating benefits in treating asymptomatic bacterial vaginosis early in pregnancy. It still needs to be determined, in larger trials, whether generalized screening and treatment for asymptomatic bacterial vaginosis in the early second trimester is beneficial and cost-effective.

Using oral clindamycin to treat women with asymptomatic bacterial vaginosis during their second trimester (between 12 and 22 weeks estimated gestational age) reduces the number of premature births and late miscarriages. The study did not demonstrate a difference in the number of neonatal intensive care unit admissions, mean birth weight, or gestational age.

This is the first study demonstrating benefits in treating asymptomatic bacterial vaginosis early in pregnancy. It still needs to be determined, in larger trials, whether generalized screening and treatment for asymptomatic bacterial vaginosis in the early second trimester is beneficial and cost-effective.

This population-based study found that women who had a false-positive mammogram had higher rates of rescreening at 18- and 30-month follow-up. In 10 years of annual screening, 50% of women will have a false-positive mammogram. However, the consequences of false-positives do not deter women from continued breast cancer screening.

When evaluating screening tests it is important to consider the effect of a false-positive test on the people being screened. The subsequent work-up for each false-positive may increase patient anxiety, total costs, and the risk of morbidity from unnecessary interventions.

This population-based study found that women who had a false-positive mammogram had higher rates of rescreening at 18- and 30-month follow-up. In 10 years of annual screening, 50% of women will have a false-positive mammogram. However, the consequences of false-positives do not deter women from continued breast cancer screening.

When evaluating screening tests it is important to consider the effect of a false-positive test on the people being screened. The subsequent work-up for each false-positive may increase patient anxiety, total costs, and the risk of morbidity from unnecessary interventions.

This population-based study found that women who had a false-positive mammogram had higher rates of rescreening at 18- and 30-month follow-up. In 10 years of annual screening, 50% of women will have a false-positive mammogram. However, the consequences of false-positives do not deter women from continued breast cancer screening.

When evaluating screening tests it is important to consider the effect of a false-positive test on the people being screened. The subsequent work-up for each false-positive may increase patient anxiety, total costs, and the risk of morbidity from unnecessary interventions.

The administration of natural progesterone decreases both the number of episodes of uterine contractions and the incidence of preterm birth in women at high risk for preterm delivery.

Previous trials used synthetic (not natural) progesterone; another placebo-controlled clinical study would be of value to evaluate safety and effects of natural progesterone. These results do not apply to women at low risk for preterm birth because this study evaluated only high-risk patients.

The administration of natural progesterone decreases both the number of episodes of uterine contractions and the incidence of preterm birth in women at high risk for preterm delivery.

Previous trials used synthetic (not natural) progesterone; another placebo-controlled clinical study would be of value to evaluate safety and effects of natural progesterone. These results do not apply to women at low risk for preterm birth because this study evaluated only high-risk patients.

The administration of natural progesterone decreases both the number of episodes of uterine contractions and the incidence of preterm birth in women at high risk for preterm delivery.

Previous trials used synthetic (not natural) progesterone; another placebo-controlled clinical study would be of value to evaluate safety and effects of natural progesterone. These results do not apply to women at low risk for preterm birth because this study evaluated only high-risk patients.

This meta-analysis showed that heliox, a mixture of helium and oxygen, offers minimal benefit during the first hour of treatment, and this benefit is not sustained. More importantly, it was not demonstrated that there was a difference in important clinical outcomes. Patients on a traditional air-oxygen mixture do just as well in the medium to long term.

Hypoxemic patients are not suitable for heliox therapy. Therefore, heliox should not be used in place of traditional oxygen or oxygen-air mixtures in acute exacerbations of asthma.

This meta-analysis showed that heliox, a mixture of helium and oxygen, offers minimal benefit during the first hour of treatment, and this benefit is not sustained. More importantly, it was not demonstrated that there was a difference in important clinical outcomes. Patients on a traditional air-oxygen mixture do just as well in the medium to long term.

Hypoxemic patients are not suitable for heliox therapy. Therefore, heliox should not be used in place of traditional oxygen or oxygen-air mixtures in acute exacerbations of asthma.

This meta-analysis showed that heliox, a mixture of helium and oxygen, offers minimal benefit during the first hour of treatment, and this benefit is not sustained. More importantly, it was not demonstrated that there was a difference in important clinical outcomes. Patients on a traditional air-oxygen mixture do just as well in the medium to long term.

Hypoxemic patients are not suitable for heliox therapy. Therefore, heliox should not be used in place of traditional oxygen or oxygen-air mixtures in acute exacerbations of asthma.

Products containing ephedrine and ephedra promote a 0.6–1.0 kg/mo weight loss over 2 to 6 months. However, the impact of these products on long-term weight loss or athletic performance is uncertain. Their use is associated with a 2- to 3-fold higher rate of psychiatric symptoms, autonomic hyperactivity, upper gastrointestinal symptoms, and heart palpitations. Several serious adverse events—such as death, myocardial infarction, and stroke—have been reported, with a rate estimated at <0.1%.

Products containing ephedrine and ephedra promote a 0.6–1.0 kg/mo weight loss over 2 to 6 months. However, the impact of these products on long-term weight loss or athletic performance is uncertain. Their use is associated with a 2- to 3-fold higher rate of psychiatric symptoms, autonomic hyperactivity, upper gastrointestinal symptoms, and heart palpitations. Several serious adverse events—such as death, myocardial infarction, and stroke—have been reported, with a rate estimated at <0.1%.

Products containing ephedrine and ephedra promote a 0.6–1.0 kg/mo weight loss over 2 to 6 months. However, the impact of these products on long-term weight loss or athletic performance is uncertain. Their use is associated with a 2- to 3-fold higher rate of psychiatric symptoms, autonomic hyperactivity, upper gastrointestinal symptoms, and heart palpitations. Several serious adverse events—such as death, myocardial infarction, and stroke—have been reported, with a rate estimated at <0.1%.

Both tricyclic antidepressants (TCAs) and opioids are more effective than placebo for the treatment of postherpetic neuralgia.

Although there was a trend toward greater pain relief with opioids, their use was associated with a higher dropout rate. Since response to one medicine did not reliably predict response to the other, either may be tried for the treatment of postherpetic neuralgia.

Both tricyclic antidepressants (TCAs) and opioids are more effective than placebo for the treatment of postherpetic neuralgia.

Although there was a trend toward greater pain relief with opioids, their use was associated with a higher dropout rate. Since response to one medicine did not reliably predict response to the other, either may be tried for the treatment of postherpetic neuralgia.

Both tricyclic antidepressants (TCAs) and opioids are more effective than placebo for the treatment of postherpetic neuralgia.

Although there was a trend toward greater pain relief with opioids, their use was associated with a higher dropout rate. Since response to one medicine did not reliably predict response to the other, either may be tried for the treatment of postherpetic neuralgia.