April 01, 2010 Archives - Clinical Advisor

Print Issue: April 01, 2010

Varenicline increases smoking cessation rates in patients with CVD

Level 1: Likely reliable evidence Guidelines for secondary prevention of cardiovascular disease (CVD) from the American Heart Association and the American College of Cardiology call for complete smoking cessation and complete avoidance of environmental tobacco smoke. While the second goal may be difficult to accomplish, a new randomized trial with 714 patients provides strong evidence…

Acute otitis media, caused by pneumcoccal infection, in a child’s ear.

In children with acute otitis media, amoxicillin may have lower rate of clinical failure compared with azithromycin

Level 2: Mid-level evidence When antibiotics are needed for treating acute otitis media (AOM) in children, amoxicillin is the first-line agent recommended by the American Academy of Pediatrics. Macrolides, such as azithromycin or clarithromycin, are recommended as alternatives for patients with type 1 hypersensitivity reactions. A recent systematic review of low-quality trials comparing macrolide antibiotics…

Dalfampridine approved for multiple sclerosis

Level 3: Lacking direct evidence Dalfampridine (Ampyra) extended release tablets, previously called Fampridine-SR, have been approved by the FDA to improve walking in patients with multiple sclerosis. In two clinical trials with 507 patients, the drug was associated with consistent improvement in walking speed on a 25-foot walk when compared with placebo (NNT 4). However,…

Cladribine and fingolimod each reduce relapse in adults with relapsing-remitting MS

Level 1: Likely reliable evidence Relapsing-remitting multiple sclerosis (MS) is commonly treated with parenteral drugs that can lead to adverse events and poor adherence. Three phase 3 randomized trials evaluated the efficacy and safety of two oral drugs, cladribine (Mylinax) and fingolimod, for patients with MS. The CLARITY trial compared cladribine vs. placebo in 1,326…

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