PPRNet Practice Guidelines
Asthma
Practice
guideline:
Controller treatment for patients with asthma at least 5 years of age and older
Inhaled corticosteroids, long-acting beta
2-agonists and leukotriene modifiers are current treatment options for long-term
control of asthma.
Strong evidence from clinical trials has established that inhaled corticosteroids improve control of asthma for children with mild or moderate persistent asthma compared to as-needed ß2-agonists, as measured by pre-bronchodilator forced expiratory volume in one second (FEV1), reduced airway hyperresponsiveness, improvements in symptom scores and symptom frequency, fewer courses of oral corticosteroids, and fewer urgent care visits or hospitalizations. Studies comparing inhaled corticosteroids to cromolyn, nedocromil, theophylline, or leukotriene receptor antagonists are limited, but available evidence shows that none of these long-term control medications appear to be as effective as inhaled corticosteroids in improving asthma outcomes.
Three systematic reviews, five subsequent and five additional RCTs have found that, in adults with mild, persistent asthma, low doses of inhaled corticosteroids (250–500 µg of beclometasone dipropionate or equivalent) versus placebo significantly improve symptoms and lung function. One systematic review found that inhaled corticosteroids versus regular ß2 agonists or versus placebo significantly improved lung function.
Additional
resources:
National
Asthma Education and Prevention Program
Upper Respiratory
Infections
Practice guideline:
Antibiotics should not be used for the
treatment of uncomplicated upper respiratory tract infections, including the
common cold, pharyngitis, or acute bronchitis in previously healthy patients
The American College of
Physicians-American Society of Internal Medicine recommends against treating
upper respiratory tract infections, which are largely viral, with antibiotics.
More evidence on
avoiding antibiotics!
Positive outcomes from delaying or avoiding antibiotics
More evidence supporting the avoidance of antibiotics in rhinosinusitis
Additional resources:
National
American
College of Physicians-ASIM Position Paper
Chlamydia Screening
Practice guideline:
Screening for genital Chlamydia in 16 to 25 year old women annually
The USPSTF strongly recommends that clinicians routinely screen all sexually active women aged 25 years and younger, and other asymptomatic women at increased risk for infection, for chlamydial infection. The USPSTF found good evidence that screening women at risk for chlamydial infection reduces the incidence of pelvic inflammatory disease and fair evidence that community-based screening reduces prevalence of chlamydial infection.
The optimal interval for screening is uncertain. For women with a previous negative screening test, the interval for re-screening should take into account changes in sexual partners. If there is evidence that a woman is at low risk for infection (e.g., in a mutually monogamous relationship with a previous history of negative screening tests for chlamydial infection), it may not be necessary to screen frequently. Re-screening at 6 to 12 months may be appropriate for previously infected women because of high rates of reinfection.
Additional
resources:
USPSTF Recommendations and Rationale