AFP Clinical Answers

Upper Gastrointestinal Bleeding, Genital Ulcers, Bacteriuria, Megestrol, Atopic Dermatitis


Am Fam Physician. 2021 Apr 15;103(8):463.

Should patients with upper gastrointestinal bleeding receive proton pump inhibitor therapy?

All patients with upper gastrointestinal bleeding should receive proton pump inhibitor therapy on presentation. Initiation of a proton pump inhibitor should not be delayed before endoscopy. Oral proton pump inhibitors can be used because oral and intravenous proton pump inhibitors have similar reductions of recurrent bleeding, surgery, or mortality. High-dose proton pump inhibitor therapy is recommended for the first 72 hours after endoscopy when the rebleeding risk is highest.

How should acute genital ulcers be managed?

Oral acyclovir, valacyclovir (Valtrex), and famciclovir (Famvir) decrease symptom duration and viral shedding for initial and recurrent episodes of herpes simplex virus outbreaks. Extensive genital ulcers may be treated with cool water or saline, topical antimicrobials, topical or oral analgesics, perineal baths, topical or oral anti-inflammatory agents, or cool compresses with Burow solution to decrease surrounding edema, inflammation, and pain. HIV screening should be completed for all people with genital, anal, or perianal ulcers not known to have HIV infection.

In what population is screening for asymptomatic bacteriuria appropriate?

The U.S. Preventive Services Task Force recommends screening for asymptomatic bacteriuria using urine culture in pregnant people. The U.S. Preventive Services Task Force recommends against screening for asymptomatic bacteriuria in nonpregnant adults.

Does the benefit of megestrol outweigh the risks in patients with cancer?

Megestrol (Megace) may be considered as nutritional support in palliative care for patients with cancer. Megestrol improves appetite in patients with anorexia-cachexia syndrome but does not improve quality of life. Megestrol is associated with an increased risk of venous thromboembolic



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