Am Fam Physician. 2024;110(4):345
Does a single intramuscular injection of nirsevimab (Beyfortus) reduce the likelihood of hospitalization for respiratory syncytial virus (RSV) in infants who do not meet criteria for receiving palivizumab?
Palivizumab is a monoclonal antibody given as a monthly injection during the winter to infants at high risk of RSV complications. A large industry-sponsored, randomized controlled trial showed that a single intramuscular dose of nirsevimab administered to average-risk infants during the winter reduced the likelihood of hospitalization due to RSV. Nirsevimab is less expensive than palivizumab and requires only a single dose.
What are the main benefits of testosterone replacement therapy for male hypogonadism?
Testosterone replacement therapy for male hypogonadism leads to modest improvements in sexual function and depressive symptoms. Patients with heart disease or high cardiovascular risk should be counseled that, despite mixed evidence, recent data show that testosterone replacement therapy does not appear to increase the risk of myocardial infarction, stroke, or cardiovascular death.
Does prenatal exposure to lamotrigine, topiramate, or valproate increase rates of autism?
In a cohort study of more than 28,000 pregnant patients with a seizure disorder, use of lamotrigine was not associated with an increase in the diagnosis of autism spectrum disorder among offspring compared with no treatment during pregnancy. Use of topiramate was associated with an increase of about 2 percentage points, and use of valproate was associated with an increase of more than 6 percentage points.
What is the recommended treatment for obstructive sialadenitis?
Sialagogues, massage, heat, and hydration are part of the initial conservative management of obstructive sialadenitis.
Does delayed antibiotic prescribing for acute bacterial conjunctivitis lead to worse therapeutic outcomes?
For acute bacterial conjunctivitis, delayed antibiotic prescribing resulted in similar symptom control as immediate prescribing while reducing antibiotic use by 50%.
Is a baseline serum urate level in adults with a history of gout accurate for predicting the risk of subsequent gout flare-ups?
According to a retrospective study from the United Kingdom that included 3,613 adult patients, in those with a history of gout, higher baseline serum urate levels were associated with an increased risk of subsequent gout flare-ups and rates of hospitalization for recurrent gout. Rates of acute gout flare-ups per 1,000 person-years were 10.6 for patients with baseline urate levels less than 6 mg per dL; 40.1 for levels 6.0 to 6.9 mg per dL; 82.0 for levels 7.0 to 7.9 mg per dL; 101.3 for levels 8.0 to 8.9 mg per dL; 125.3 for levels 9.0 to 9.9 mg per dL; and 132.8 for levels 10 mg per dL or greater.
Additional Online Only AFP Clinical Answers
Which medications may be used for augmentation in the management of treatment-resistant depression?
Switching to or augmenting with another antidepressant class or adding psychotherapy is recommended for patients who have depression with partial response to optimized initial treatment. Augmentation with a second-generation antipsychotic is effective for treatment-resistant depression, defined as absence of remission despite trials of two or more antidepressant medications with adherence to adequate dosing and duration.
How should you rule out fracture in an older adult who has fallen?
Plain radiography is usually the first imaging test when evaluating an older adult who has fallen, but studies show a negative result does not exclude fractures of ribs, thoracic and lumbar spine, and pelvic ring. If suspicion of injuries persists after radiography, computed tomography is warranted; whole-body computed tomography (pan-scan) including head, cervical spine, chest, abdomen, and pelvis may be considered.
Does oseltamivir reduce the likelihood of hospitalization in adults with influenza?
A 2024 meta-analysis found no evidence that oseltamivir reduces the likelihood of hospitalizations in adults with influenza, including high-risk or older patients; however, it has relatively common and nonserious harms.
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