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Am Fam Physician. 2022;106(5):498

What empiric antibiotic therapy should be considered for CAP in adult outpatients without comorbid conditions?

Empiric antibiotic therapy for community-acquired pneumonia (CAP) in adult outpatients without comorbid conditions should include high-dose amoxicillin, doxycycline, or a macrolide (if local macrolide resistance rates for pneumococcus are less than 25%).

What empiric antibiotic therapy should be considered for CAP in adult outpatients with comorbid conditions?

Amoxicillin/clavulanate (Augmentin) or a third-generation cephalosporin combined with doxycycline or a macrolide, or monotherapy with a respiratory fluoroquinolone is recommended for empiric CAP treatment in adults with comorbid conditions (e.g., heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; asplenia).

Is routine laboratory testing recommended for preoperative evaluation in children?

Routine laboratory testing is not recommended for healthy children and adolescents having low-risk procedures (i.e., minimal bleeding risk and low likelihood of cardiopulmonary and neurologic complications).

Are SSRIs and SNRIs safe and effective for the treatment of premature ejaculation?

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) increase the ejaculatory latency time (mean difference = 3.09 minutes; 95% CI, 1.94 to 4.25 minutes) and improve the satisfaction of the experience (relative risk [RR] = 1.63; 95% CI, 1.42 to 1.87) compared with placebo. However, adverse effects cause a substantial number of men to stop treatment (RR = 3.80; 95% CI, 2.61 to 5.51).

When should IgA tTG serologic testing be performed to screen for suspected celiac disease?

Immunoglobulin A tissue transglutaminase (IgA tTG) serologic testing should be offered as an initial screening test for the diagnosis of suspected celiac disease in all age groups. Classic symptoms include diarrhea, abdominal pain, bloating, weight loss, malabsorption, and failure to thrive. All serologic testing for suspected celiac disease should be performed after patients have been on a gluten-containing diet for two to six weeks.

What is the preferred method for providing nutrition to patients with acute pancreatitis?

Compared with parenteral nutrition, enteral feeding is associated with shorter hospitalizations and reductions in mortality, multiorgan failure, infection, and other complications. Early enteral feeding as tolerated is recommended over restricting oral intake.

Additional Online Only AFP Clinical Answers

How effective is oral vitamin B12 supplementation compared with intramuscular supplementation in patients with vitamin B12 deficiency?

For normalizing serum vitamin B12 levels, oral and intramuscular vitamin B12 supplementation are equivalent after one to four months.

Who should be screened for lung cancer with low-dose CT?

Adults 50 to 80 years of age who have a 20 pack-year smoking history and currently smoke or have quit smoking within the past 15 years should undergo annual low-dose CT screening.

What topical therapy is effective in treating psoriasis?

Topical corticosteroids are the most effective topical agent for psoriasis plaques. Topical calcineurin inhibitors, vitamin D analogues, and tazarotene (Tazorac) are also effective and can limit chronic topical corticosteroid use.

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