Clinical Inquiries, 2006
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Item Treatment of Herpes Zoster(Family Physicians Inquiries Network, 2006) Holten, Keith B.; Britigan, Denise H.Resolution of acute pain related to herpes zoster is accelerated with any of the following: oral acyclovir (Zovirax) 800 mg five times daily for seven days; valacyclovir (Valtrex) 1,000 mg three times daily for seven days; or famciclovir (Famvir) 750 mg once daily, 500 mg twice daily, or 250 mg three times daily for seven days. (Strength of recommendation: A) Oral corticosteroids given during the acute phase of the illness have not been shown to reduce the incidence or severity of postherpetic neuralgia. (Strength of recommendation: B) There is no evidence to support the use of tricyclic antidepressants or anticonvulsants for the management of herpes zoster. (Strength of recommendation: B)Item Treatments for Chronic Prostatitis(Family Physicians Inquiries Network, 2006) Meza, James; Alam, Shah; Martin, Sandra I.Because the etiology of chronic nonbacterial prostatitis is unknown, a variety of treatments have been proposed. The best- designed, largest clinical trials have not found the most commonly used therapies (i.e., alpha blockers, quinolone antibiotics, nonsteroidal anti-inflammatory drugs, finasteride [Propecia]) to be effective. [Strength of recommendation: B, randomized controlled trials (RCTs)] Allopurinol (Zyloprim), phytochemicals, and transurethral thermotherapy have been suggested as treatment options, but evidence of their effectiveness is lacking. [Strength of recommendation: B, expert opinion or inconclusive trials]Item Risks and Benefits of Combination Contraceptives(Family Physicians Inquiries Network, 2006) Roederer, Mary W.; Blackwell, JeanThe risks of using oral combination contraceptives include: a three- to sixfold increase in the incidence of venous thromboembolism (VTE) apparent by the fourth month of use and highest between six and 12 months of use; a two- to sixfold increase in the risk of ischemic stroke among women with a history of migraine; and an increase in cervical cancer risk after five or more years of use. (Strength of Recommendation [SOR]: B)Item Vaginal Misoprostol for Cervical Ripening in Term Pregnancy(Family Physicians Inquiries Network, 2006) Weaver, Sally P.; Cook, Jessica; Nashelsky, JoanLow-dose (25 mcg) intravaginal misoprostol appears to be safe and effective for cervical ripening in term pregnancy for patients without a history of cesarean section. Compared with other cervical ripening methods, misoprostol has an increased rate of vaginal delivery within 24 hours without significant differences in cesarean section rates or fetal outcomes. (Strength of recommendation: B, systematic review of randomized controlled trials)Item Urine Dipstick for Diagnosing Urinary Tract Infection(Family Physicians Inquiries Network, 2006) Wright, Olivia Rae; Safranek, SarahThe sensitivity and specificity of the urine dipstick varies somewhat with the setting and population, as does its recommended interpretation. In low-risk patients with a low pretest probability of UTI, the urine dipstick alone is useful to exclude infection if both nitrites and leukocyte esterase are negative. [Strength of recommendations: C, all recommendations based on meta-analyses of cohort studies not addressing patient-oriented outcomes]