Clinical Inquiries, 2007
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Item Best Alternatives to Statins for Treating Hyperlipidemia(Family Physicians Inquiries Network, 2007) Bouknight, Patricia; Mackler, Leslie; Heffington, MarkMost alternatives to statin therapy reduce cholesterol levels but do not consistently demonstrate a reduction in cardiac-related and all-cause mortality in patients with or without coronary heart disease (CHD). Fibrates and niacin decrease the risk of major coronary events; however, no statistically significant reductions in mortality have been shown. (Strength of Recommendation [SOR]: A, based on systematic review of randomized controlled trials [RCTs]). Resins decrease cardiovascular mortality but not total mortality. (SOR: A, based on review of RCTs). The effects of ezetimibe (Zetia) on cardiovascular outcomes and mortality are unknown. (SOR: C, based on a single RCT with disease-oriented evidence). Omega-3 fatty acid supplementation does not clearly demonstrate reductions in mortality. (SOR: A, based on two meta-analyses of RCTs). There is insufficient evidence to recommend the use of herbal therapy for the treatment of hyperlipidemia. (SOR: A, based on a systematic review of RCTs).Item Which UTI therapies are safe and effective during breastfeeding?(Family Physicians Inquiries Network, 2007) Kaiser, Jessica; McPherson, Vanessa; Kaufmann, LeonoraTrimethoprim/sulfamethoxazole (TMP/SM X) has a high success rate in eradicating bacteriuria for women with urinary tract infection and is compatible with breastfeeding (strength of recommendation: C, based on extrapolation from studies with nonlactating women and disease-oriented outcomes). Quinolones (ciprofloxacin, ofloxacin) are effective and probably compatible with breastfeeding; however, their use has not been recommended by many investigators based on arthropathy in animal studies (SOR: C, based on extrapolation from case series and disease-oriented outcomes). A 7-day course of nitrofurantoin has similar efficacy to TMP/SMX and is compatible with breastfeeding, but it should be avoided in populations at risk for glucose-6-phosphate dehydrogenase (G6PD) deficiency (also known as favism, most often found in patients of Mediterranean or African descent) (SOR: C, extrapolation from studies in nonlactating women and disease-oriented outcomes).Item Angiotensin Blockade in Patients with Diabetic Nephropathy(Family Physicians Inquiries Network, 2007) Jimenez, Julio; Safranek, SarahWhen used to delay the progression of early nephropathy in patients with type 2 diabetes mellitus, angiotensin receptor blockers (ARBs) are not superior to angiotensin-converting enzyme (ACE) inhibitors. (Strength of Recommendation: C, multiple randomized controlled trials [RCTs]).Item Glycemic Control in Patients with Type 2 Diabetes(Family Physicians Inquiries Network, 2007) Glendenning, Charles; Kaufmann, LeeThere is no clearly superior oral agent for glycemic control in patients with type 2 diabetes. (Strength of Recommendation [SOR]: C) Metformin (Glucophage) has shown additional benefit when compared with other treatments (including insulin) for diabetes-related outcomes and all-cause mortality and should be considered the agent of choice for initial monotherapy, particularly in obese patients. (SOR: A)Item Evaluation of Apparent Life-Threatening Events in Infants(Family Physicians Inquiries Network, 2007) Warren, Johanna; Biagioli, Frances E.; Hamilton, AndrewA comprehensive, detailed history and physical examination with pulse oximetry and nondilated funduscopy (to look for traumatic retinal hemorrhage) helps to determine the underlying etiology of an apparent life-threatening event (ALTE) in 70 percent of infants. (Strength of Recommendation [SOR]: C, based on case series). Initial diagnostic evaluation should include 12-lead electrocardiography (ECG); blood gas analysis; chest radiography; complete blood count (CBC); pertussis and respiratory syncytial virus cultures, if respiratory symptoms are present; serum electrolytes; and urinalysis. (SOR: C, expert opinion and case series).