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Am Fam Physician. 2021;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 events when given during chemotherapy and may increase the risk of symptomatic adrenal suppression.

What are some first-line therapies used for atopic dermatitis flare-ups?

Emollients should be used as the primary therapy for atopic dermatitis flare-ups and maintenance. Topical corticosteroids should be used as first-line treatment for atopic dermatitis flare-ups. Topical calcineurin inhibitors may be used as first-line treatment for moderate to severe atopic dermatitis in combination with topical corticosteroids. Once-daily bathing with lukewarm water limited to five to 10 minutes is recommended.

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