AFP Clinical Answers
Warfarin Dosages, PCOS, Varicose Veins, Gastroenteritis in Children, Plantar Fasciitis
Am Fam Physician. 2020 Jan 1;101(1):10.
Which antimicrobials have a high enough risk of interacting with warfarin to warrant empiric adjustments in warfarin dosage?
Empiric warfarin dosage reductions should be considered with concomitant use of trimethoprim/sulfamethoxazole, fluconazole (Diflucan), and/or metronidazole (Flagyl). Conversely, an empiric warfarin dosage increase should be considered with concomitant use of rifampin. Knowledge of previous exposure and response should be considered. Regardless of the antimicrobial, the international normalized ratio should be checked within three to five days of initiation and within three to five days after discontinuation of the antimicrobial.
Are aromatase inhibitors such as letrozole effective treatments for subfertile women with PCOS who are trying to conceive?
When treated with letrozole (Femara), subfertile women with polycystic ovary syndrome (PCOS) who are trying to conceive have increased chances of pregnancy (number needed to treat [NNT] = 11) and live birth (NNT = 10) compared with those treated with clomiphene (Clomid). The risk of adverse outcomes, including miscarriage, ovarian hyperstimulation syndrome, and multiple pregnancy, is not increased.
What conservative therapies are effective in the treatment of varicose veins?
There is not enough evidence to determine if compression stockings are effective in the treatment of varicose veins in the absence of active or healed venous ulcers. Horse chestnut seed extract (Aesculus hippocastanum) and other phlebotonics may ease the symptoms of varicose veins, but long-term studies of the safety and effectiveness of phlebotonics are lacking.
Is the probiotic L. rhamnosus GG safe and effective for the treatment of acute gastroenteritis in young children?
Treatment with the probiotic Lactobacillus rhamnosus GG in a large, well-designed randomized trial did not result in faster symptomatic improvement or less moderate or severe diarrhea in young children with acute gastroenteritis.
What interventions are effective for plantar fasciitis/fasciopathy?
Plantar fascia stretches are effective for reducing heel pain. Foot orthoses (prefabricated or custom) may reduce heel pain for up to 12 weeks, but the benefit is generally not clinically meaningful in the long term. The role of night splints in reducing plantar fasciitis pain is inconclusive.
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