Print Issue: March 01, 2009

Antibiotic-induced diarrhea

To reduce the risk of antibiotic-associated diarrhea, I recommend yogurt with live cultures. The yogurt also helps settle diarrhea after a bout of gastroenteritis. I have my patients try the yogurt for one or two days before getting stool specimens.—Patricia L. Kress, MD, Eau Claire, Wis. (125-10)

Standard of care for MRSA infections

The idea that methicillin-resistant Staphylococcus aureus (MRSA) abscesses don’t always require antibiotics (Item 122-5) may have been accepted in 1950, but it is not true anymore. All clinicians know that every family member should be treated once MRSA is diagnosed. Once again, the CDC is behind on its protocols. Treatment should consist of appropriate oral…

ADHD treatment without stimulants

What attention-deficit hyperactivity disorder (ADHD) treatment alternatives are available for a child who has an adverse reaction to stimulants? Atomoxetine (Strattera) has been ineffective.—Janine Fiorello, PNP, Farmingdale, N.Y. Be sure that ADHD is the only diagnosis you are treating. If there are comorbid conditions, there may be additional therapeutic possibilities. As you know, stimulants are…

Dosing adjustments for obese children

What dosing adjustments should be made to medications in children who are morbidly obese and weigh as much as an adult? Should I stop at the maximum dose for a child of “normal” weight?—Judy Snow, MS, ARNP-C, Lakeland, Fla. As a rule of thumb, never prescribe more than the maximum adult dose for a child,…

Treatment includes compression therapy and a simple adherent dressing.

Chronic foot and leg ulcer treatment

I frequently use Unna boots or DuoDerm or Vigilon dressings to treat chronic leg/foot ulcers. While these treatments eventually work most of the time, is there a more efficient approach?—CORBIN ROGERS, MHS, PA-C, Denver Tailoring the treatment to the cause and etiology of the leg ulcer is the most important step in wound therapy. Malnutrition…

CT showing a large infarct in the left hemisphere of a stroke patient

t-PA increases intracranial hemorrhage, but functional outcomes are inconsistent

Level 1: Likely reliable evidenceThe randomized placebo-controlled European Cooperative Acute Stroke Study III (ECASS III) evaluated alteplase (Activase, tissue-type plasminogen activator [t-PA]) in 821 patients aged 18-80 years with acute ischemic stroke (N Engl J Med. 2008;359:1317-1329). Alteplase 0.9 mg/kg (up to 90 mg) or placebo was given IV within 3-4.5 hours of non-severe stroke…

Exercise reduces pain and improves function in patients with knee osteoarthritis

Level 1: Likely reliable evidenceTherapeutic exercise of the knee (strength training in particular) reduces pain and improves physical function in patients with knee osteoarthritis, based on two systematic reviews. A Cochrane review of 32 randomized trials compared land-based therapeutic exercise vs. nonexercise (Cochrane Database Syst Rev. 2008[4]:CD004376). Exercise reduced knee pain in a meta-analysis with…

For probable TB, use NAA test

Although culture remains the gold standard for laboratory confirmation of TB, the CDC now recommends that nucleic acid amplification (NAA) testing become standard practice in helping to diagnose people in whom pulmonary TB is moderately to highly suspected (MMWR. 2009;58:7-10).  The NAA test has been commercially available in the United States since the late 1990s.…

Early insulin infusion vor VLBW infants may increase mortality and hypoglycemia

Level 2: Mid-level evidenceEarly continuous insulin infusion in very-low-birth-weight (VLBW) infants aged 1-7 days is associated with significantly increased mortality at 28 days and increased hypoglycemia, based on an open-label randomized trial involving 389 participants (N Engl J Med. 2008;359:1873-1884). In infants receiving insulin, mortality at 28 days was 11.9% (vs. 5.7% with standard care);…

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