AFP Clinical Answers
Hypertension, Pregnancy, Prostate Cancer, Short-Course Antibiotics, Anticonvulsants
Am Fam Physician. 2020 Apr 15;101(8):460.
Is a single office-based blood pressure measurement reliable to assess hypertension?
Do not rely on a single blood pressure measurement. The first blood pressure reading taken during an office visit will be substantially different than subsequent readings in almost one-half of typical patients and, if relied on, will result in one out of eight patients being falsely labeled as hypertensive.
How should patients be counseled about a repeat pregnancy after a recent delivery?
Women should be advised to avoid interpregnancy intervals (the time between birth and the start of the next pregnancy) shorter than six months and be counseled about the risks and benefits of intervals shorter than 18 months. Clinicians should review women's prescription and nonprescription medications and environmental exposures for potential teratogens before the next pregnancy and prescribe folic acid supplementation. All women should be asked about their use of tobacco, alcohol, and drugs and be counseled about cessation.
Is genomic testing an effective means of diagnosing prostate cancer?
Prolaris is a genomic test that analyzes changes in 46 genes in prostate biopsy tissue. The Prolaris test generates a risk score to help predict the likelihood of disease progression in men with localized prostate cancer. Prolaris testing improves the accuracy of prognosis for patients with prostate cancer, especially patients with low- or intermediate-grade disease who may be deciding between interventional and noninterventional treatment approaches. However, it is premature to recommend use of this test outside of the research setting, given the high cost and lack of evidence that it improves patient-oriented outcomes.
Are short courses of antibiotics as effective as longer courses for common outpatient infections?
When someone asks, “Can I get away with a shorter course of antibiotics?” almost every time the answer is, “Yes, you can.” Shorter courses reduce costs and may reduce the likelihood of adverse events in antibiotic treatment of streptococcal pharyngitis, community-acquired pneumonia, otitis media, acute sinusitis, urinary tract infection, and acute pyelonephritis.
Are anticonvulsants an effective treatment for low back pain?
The use of anticonvulsants, such as gabapentin (Neurontin), for painful conditions has increased greatly in recent years. However, a systematic review found good evidence that these drugs are not effective for the treatment of low back pain, with or without radiculopathy, and are associated with an increased risk of adverse events.
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