Oct 30

Starting allopurinol in acute gout

Journal reference: Hill EM, Sky K, Sit M, Collamer A, Higgs J. Does starting allopurinol prolong acute treated gout? A randomized clinical trial. J Clin Rheumatol 2015;21(3):120-5.

Link: http://www.ncbi.nlm.nih.gov/pubmed/25807090

Published: April 2015

Evidence cookie says…

It is unclear what effect starting allopurinol in acute has on symptoms, due to the lack of good evidence.

  • it may be preferable to avoid starting allopurinol in an acute attack
  • this should not be a dogmatic stance

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Sep 04

Corticosteroid injections for tennis elbow

Journal reference: Olaussen M, Holmedal O, Lindbaek M, Brage S, Solvang H. Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ Open 2013;3(10):e003564

Link: http://dx.doi.org/10.1136/bmjopen-2013-003564

Published: 29 October 2013

Evidence cookie says…

Corticosteroid injections should be generally avoided for tennis elbow (lateral epicondylitis).

They are associated with:

  • increased likelihood of improvement in the short term (4-12 weeks)
  • reduced likelihood of improvement in the intermediate (26 weeks) and long term (52 weeks)

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Jul 10

Pelargonium sidoides extract (Kaloba (R)) for the common cold

Journal reference: Timmer A, Günther J, E Motschall, Rücker G, Antes G, Kern WV. Pelargonium sidoides extract for acute respiratory tract infections Treating. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No .: CD006323.

Link: http://dx.doi.org/10.1002/14651858.CD006323.pub3

Published: 22 October 2013

Evidence cookie says…

There exists only very-low quality evidence of the effect of Pelargonium sidoides extract (Kaloba ®, Umckaloabo) on the common cold.

This precludes it from being recommended routinely in primary care settings.

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May 15

Paracetamol for acute low-back pain

Journal reference: Williams CM, Maher CG, Latimer J, McLachlan AJ, Hancock MJ, Day RO, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet 2014;384(9954):1586-96.

Link: http://dx.doi.org/10.1016/S0140-6736(14)60805-9

Published: 1 November 2014

Evidence cookie says…

Paracetamol (regular and intermittent dosing) does not have an effect on time to recovery for acute low-back pain in the general practice setting.

Recommendations for the use of regular adult dosing of paracetamol should be reconsidered.

The median time to recovery from acute low-back pain is 16-17 days.

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Mar 13

Yoghurt to prevent antibiotic-associated diarrhoea in children

Journal reference: Fox MJ, Ahuja KD, Robertson IK, Ball MJ, Eri RD. Can probiotic yogurt prevent diarrhoea in children on antibiotics? A double-blind, randomised, placebo-controlled study. BMJ Open 2015;5(1): e006474. DOI: 10.1136/bmjopen-2014-006474

Link: http://dx.doi.org/10.1136/bmjopen-2014-006474

Published: 14 January 2015

Evidence cookie says…

Probiotic yoghurt appears to reduce the incidence of diarrhoea in children receiving antibiotics in general practice settings.

The dose was 2 x 100 g tubs of Vaalia-brand yoghurt daily during the antibiotic course of treatment.

This is a reasonable preventive intervention to advise – especially for children who enjoy yoghurt.

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Nov 07

St John’s wort for minor depression

Journal reference: Rapaport MH, Nierenberg AA, Howland R, Dording C, Schettler PJ, Mischoulon D. The treatment of minor depression with St. John’s Wort or citalopram: failure to show benefit over placebo. Journal of Psychiatric Research 2011; 45(7): 931-941. DOI: 10.1016/j.jpsychires.2011.05.001

Link: http://dx.doi.org/10.1016/j.jpsychires.2011.05.001

Published: July 2011

Evidence cookie says…

St John’s wort is probably ineffective for minor depression.

Of the little evidence available, there appears to be no benefit over placebo, and evidence of side-effects.

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Sep 05

Does caffeine help with migraines?

Journal reference: Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009281.

Link: http://dx.doi.org/10.1002/14651858.CD009281.pub2

Published: 14 March 2012

Evidence cookie says…

Oral caffeine (100 mg) as a single dose may have a modest effect on acute pain (including migraine) when used as an adjuvant to oral analgesia (including paracetamol).

There are significant uncertainties in the evidence-base and this finding should be treated cautiously.

There is an absence of evidence for repeated doses of caffeine.

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Jul 11

Echinacea and the common cold in children

Journal reference: Taylor JA, Webber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA 2003; 290(21): 2824-2830

Link: http://dx.doi.org/10.1001/jama.290.21.2824

Published: 3 December 2003

Evidence cookie says…

Echinacea does not appear to be an effective treatment for the common cold in children.

Side-effects (such as rash and allergic reactions) can occur and the UK regulatory body (MHRA) recommends against its use in children under 12 years.

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May 16

Newer oral contraceptives and risk of venous thrombosis

Journal reference: de Bastos M, Stegeman BH, Rosendaal FR, Van Hylckama Vlieg A, Helmerhorst FM, Stijnen T, Dekkers OM. Combined oral contraceptives: venous thrombosis. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD010813. DOI: 10.1002/14651858.CD010813.pub2.

Link: http://dx.doi.org/10.1002/14651858.CD010813.pub2

Published: 3 March 2014

Evidence cookie says…

Combined oral contraceptives containing drospirenone as compared to levonorgestrel are associated with twice the risk of venous thrombosis (and about 4x the risk of non-use).

However, the absolute risk difference is small: less than 0.1% increased probability of venous thrombosis per year (NNH ≈ 1500).

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Apr 16

Diagnostic utility of rheumatoid factor in low risk population

Journal reference: Nishimura K, Sugiyama D, Kogata Y, Tsuji G, Nakazawa T, Kawano S, et al. Meta-analysis: diagnostic accuracy of anti-cyclic citrullinated peptide antibody and rheumatoid factor for rheumatoid arthritis. Ann Intern Med 2007; 146(11): 797-808; and others.

Link: http://dx.doi.org/10.7326/0003-4819-146-11-200706050-00008

Published: 5 June 2007

Evidence cookie says…

There is no role for diagnostic rheumatoid factor (RF) testing in someone without inflammatory arthritis.

An elevated RF increases the odds of rheumatoid arthritis about 5-fold.  The post-test risk, however, depends on the pre-test risk.

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