It’s now debatable whether we should give antibiotics for uncomplicated diverticulitis. While there isn’t sufficient evidence to say definitively that we shouldn’t, there are now a few trials showing that they don’t do anything, which certainly gives cause to question their routine use. (Cochrane Review CD009092)

If you do give antibiotics – for that or anything else – a meta-analysis in the Annals of Internal Medicine (published online 13th Nov) has now confirmed that it is worth advising probiotics. The NNT is actually slightly higher than that which I saw in a previous study – 1 in 30. Probiotics used in the studies included Bifidobacterium, Lactobacillus, Saccharomyces, and Streptococcus.

General health checks in adults don’t seem to do anything very helpful. They increase the number of new diagnoses, but don’t benefit morbidity or mortality. (BMJ 2012; 345:e7191)

On the same theme of not doing too much, don’t measure HbA1c too often. The paper Optimal Prescribing of Glucose Lowering Therapy for Patients With Type 2 Diabetes found that annual monitoring was optimal, except when patients were close to the threshold, when six-monthly monitoring might be worthwhile. Monitoring more frequently was more likely to pick up false positives.

I was interested to read in a Prescriber article that, according to a Cochrane review in 2007 (CD003244), there are no clinical differences between efficacy (or adverse effects) between PPIs at equivalent doses. So why are we so often advised to put resistant patients onto esomeprazole?

And there’s yet another reason to give up smoking – in a study by Goesling and Toda reported at the International Association for the Study of Pain 14th World Congress, smoking in chronic pain patients was found to be associated with more severe pain. Ex-smokers had similar scores to never smokers. Of course, there’s the reverse causality problem again, but it’s still something worth mentioning to smokers.


About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2012, Diabetes, Endocrinology, Gastroenterology, Pain control. Bookmark the permalink.

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