Jul 03

Should PPIs be routinely co-prescribed with long-term NSAIDs?

Journal reference: Rostom A, Dube C, Wells G, et al. Prevention of NSAID-induced gastroduodenal ulcers. Cochrane database of systematic reviews 2002(4):CD002296.

Link: https://doi.org/10.1002/14651858.CD002296

Published: June 2011

Evidence cookie says…

Proton-pump inhibitors (PPIs) protect against the development of ulcers seen on endoscopy, in patients taking longer-term NSAIDs

  • little data exists on clinical outcomes
  • prophylaxis should be considered for patients at increased risk of gastrointestinal toxicity

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Jun 09

NSAIDs as treatment for uncomplicated urinary tract infections

Journal reference: Gagyor I, Bleidorn J, Kochen MM, Schmiemann G, Wegscheider K, Hummers-Pradier E. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. Bmj 2015 Dec 23;351:h6544.

Link: http://doi.org/10.1136/bmj.h6544

Published: December 2015

Evidence cookie says…

NSAIDs should not be recommended as a first line treatment for uncomplicated UTIs in women

  • compared with women who received empirical antibiotics, those who received regular ibuprofen as treatment experienced more UTI symptoms
  • however, most of the women who received NSAIDs did recovery from the UTI and used less antibiotics

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Mar 01

Duct tape to treat cutaneous warts

Journal reference: Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R. Topical treatments for cutaneous warts. Cochrane database of systematic reviews 2012 Sep 12(9):CD001781

Link: http://dx.doi.org/10.1002/14651858.CD001781.pub3

Published: September 2012

Evidence cookie says…

Duct tape should not be routinely recommended as wart therapy.

  • There is no compelling evidence that duct tape is more effective than placebo.

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Dec 05

Milk thistle for chronic hepatitis B

Journal reference: Rambaldi A, Jacobs BP, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane database Syst Rev 2007 Oct 17(4):CD003620

Link: https://dx.doi.org/10.1002/14651858.CD003620.pub3

Published: October 2007

Evidence cookie says…

Milk thistle products cannot be recommended for chronic hepatitis B.

  • There is limited/minimal research evidence available.
  • What evidence exists is of unclear quality.

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Oct 10

Sterile water injections for acute low back pain

Journal reference: Cui JZ, Geng ZS, Zhang YH, Feng JY, Zhu P, Zhang XB. Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial. Braz J Med Biol Res 2016 Mar;49(3)

Link: http://dx.doi.org/10.1590/1414-431X20155092

Published: March 2016

Evidence cookie says…

Sterile water injections are of uncertain value in acute low back pain.

  • Routine use of this intervention cannot be recommended based on a single study that has important threats to its internal validity.
  • It may have a role in patients who consent after being informed to its uncertain value.

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Aug 08

Does co-enzyme Q10 reduce statin-related muscle pain?

Journal reference: Banach M, Serban C, Sahebkar A, et al. Effects of coenzyme Q10 on statin-induced myopathy: a meta-analysis of randomized controlled trials. Mayo Clin Proc 2015 Jan;90(1):24-34.

Link: http://dx.doi.org/10.1016/j.mayocp.2014.08.021

Published: January 2015

Evidence cookie says…

The effect of CoQ10 on muscle pain in people on statin therapy is uncertain.

  • The research evidence is of limited quality and inconsistent.
  • The range of best estimates includes no effect.
  • CoQ10 cannot be recommended as a matter of routine supplementation to prevent muscle pain in people taking statins.

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Jun 14

Metformin as prevention in people taking antipsychotic medication

Journal reference: Zheng W, Li XB, Tang YL, Xiang YQ, Wang CY, de Leon J. Metformin for Weight Gain and Metabolic Abnormalities Associated With Antipsychotic Treatment: Meta-Analysis of Randomized Placebo-Controlled Trials. J Clin Psychopharmacol 2015 Oct;35(5):499-509.

Link: http://dx.doi.org/10.1097/JCP.0000000000000392

Published: October 2015

Evidence cookie says…

The effect of metformin on cardiovascular disease in people living without diabetes on long-term antipsychotic medication is unknown.

  • evidence exists on a number of surrogate endpoints that are CVD risks factors
  • this evidence is heterogenous and its quality is not high
  • metformin may have a small-to-moderate effect on weight gain

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Feb 19

Aspirin as DVT prophylaxis for high risk long-haul travellers

Journal reference: Cesarone MR, Belcaro G, Nicolaides AN, et al. Venous thrombosis from air travel: the LONFLIT3 study–prevention with aspirin vs low-molecular-weight heparin (LMWH) in high-risk subjects: a randomized trial. Angiology 2002 Jan-Feb;53(1):1-6.

Link: http://www.ncbi.nlm.nih.gov/pubmed/11863301

Published: Jan 2002

Evidence cookie says…

It is unclear whether aspirin is effective as DVT prophylaxis for high risk long-haul travellers.

  • the single, poorly described study suggests that it may be less effective than enoxaparin (Clexane)
  • the lack of evidence should preclude it from being recommended

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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 gout 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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