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Am Fam Physician. 2022;105(5):462

What is the preferred medication for diabetes mellitus management in patients with end-stage renal disease?

Insulin is preferred for most patients who require medication. When the estimated glomerular filtration rate falls below 30 mL per minute per 1.73 m2, many diabetes medications, including metformin, are contraindicated.

What tests are performed in the diagnostic workup for vocal cord dysfunction?

The diagnostic workup for vocal cord dysfunction includes nasolaryngoscopy and pulmonary function testing (with provocative exercise and possibly methacholine).

Does periodontal disease contribute to the development of other diseases?

Researchers in the United Kingdom found that patients with a documented diagnosis of periodontal disease were more likely than those without to have additional chronic diseases, including cardiovascular disease, autoimmune disease, and mental illness. This serves as a reminder that family physicians care for the entire person, including their oral health, and should encourage regular dental care.

Does light therapy decrease depression in older adults with seasonal depression?

Based on two systematic reviews and meta-analyses, light therapy appears to be mildly effective in treating depression in older adults, but the ideal wavelength, intensity, and length of treatment are unknown. Bright white light exposure in the mornings for less than 60 minutes may be most effective.

Are oral antibiotics adequate treatment for septic arthritis?

Oral antibiotics are not inferior to intravenous antibiotics for the treatment of septic arthritis, according to a study evaluating six weeks of therapy started within one week of surgery or treatment with intravenous antibiotics.

Should oral anticoagulation and antiplatelet therapies be discontinued before routine dental cleaning and tooth extractions?

For simple cleanings or single tooth extractions, it is reasonable to continue oral anticoagulation and antiplatelet therapies at therapeutic doses.

Can ultrasonography be used for the diagnosis of pneumonia in children?

Chest ultrasonography can be used in place of chest radiography for accurate diagnosis of pneumonia in children.

Additional Online Only AFP Clinical Answers

For whom is hepatitis A vaccination recommended?

Hepatitis A vaccination should be offered to children 12 to 23 months of age and other populations at increased risk such as people who use illegal drugs, those who travel to areas with high or intermediate rates of endemic infection, men who have sex with men, incarcerated populations, people experiencing homelessness, and persons at high risk of severe disease from hepatitis A, such as those with chronic liver disease or HIV infection.

What is the first-line treatment for outpatient management of community-acquired pneumonia in children?

Amoxicillin is the treatment of choice for community-acquired pneumonia in school-aged children in the outpatient setting.

Do probiotics reduce the risk of developing Clostridioides difficile colitis?

There may be a benefit for the use of probiotics to reduce the risk of acquiring C. difficile-associated diarrhea, especially in patients who are hospitalized and receiving antibiotics. A 2017 Cochrane meta-analysis assessed the use of probiotics to prevent C. difficile-associated diarrhea and found a number needed to treat of 42 among all study participants and 12 among patients at high risk. Of note, the authors acknowledged that of the 39 included studies, 27 had high or unclear risk of bias. The definitions of high risk varied among studies, but included age 65 years and older, hospital or nursing facility admission, immunocompromise, or a previous history of C. difficile-associated diarrhea.

Editor's Note: Several of the answers above first appeared in the new AFP Clinical Answers email, which is sent each month to recipients of the AFP email table of contents. Sign up to receive AFP emails.

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