Primary Care Corner with Geoffrey Modest MD: Take the full course of antibiotics???

A recent BMJ analysis article argued that taking the “full course of antibiotics” is often likely counterproductive (see doi: 10.1136/bmj.j3418 )​. Details: –international health organizations and the WHO have pushed for completing antibiotic regimens: a 2016 WHO advisory to patients stated “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of […]

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Primary Care Corner with Geoffrey Modest MD: PPIs and increased mortality

A large longitudinal study of US veterans found a 25% increased risk of death associated with proton pump inhibitor (PPI) usage (see doi.org/ 10.1136/ bmjopen-2016-015735)​. Details: — the researchers assessed three cohorts of patients, with 5.7 years of follow-up after the first acid suppression therapy prescription was written, and all patients had at least one outpatient serum creatinine […]

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Primary Care Corner with Geoffrey Modest MD: Decreasing opiate prescriptions

by Dr Geoffrey Modest   Some (likely) good news about prescription opioids from the CDC (see https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm?s_cid=mm6626a4_w ).   — Opioid prescribing in the United States between 2006 and 2015 peaked in 2010 at 782 morphine milligrams equivalents (MME) per capita then decreased annually to 640 MME per capita in 2015 — there was pretty striking variation by US county, from […]

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Primary Care Corner with Geoffrey Modest MD: Dyspepsia guidelines

by Dr Geoffrey Modest ​​The American College Of Gastroenterology and the Canadian Association of Gastroenterology updated their guidelines on the management of dyspepsia (see doi: 10.1038/ajg.2017.154​)   Recommendations (note: the recommendation is much weaker when they use the word “suggest” vs “recommend”): — they suggest endoscopy for dyspepsia patients greater than 60 years old: conditional recommendation/very low-quality evidence. […]

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