CLINICAL PEARLS FOR AUGUST 2022
CIGARETTE SMOKING: The most effective method to quit smoking involves “individual or group counseling, guaranteed financial incentives, and text message-based and counseling.” These methods all are more effective when accompanied by smoking cessation drug therapy. The combination of pharmacotherapy and behavioral interventions is more effective than either method alone.
COVID-19 TREATMENT: Azithromycin (Z-pack, Zithromax) is the most frequently studied antibiotic used for treating COVID-19. However, these studies show it doesn’t improve mortality for hospitalized or outpatient adults, doesn’t affect the clinical course during hospitalization, and doesn’t reduce the risk of hospitalization for outpatients. This makes sense scientifically because antibiotics are completely ineffective against viruses, such as COVID-19.
APHTHOUS STOMATITIS (Oral Cold Sores): Painful cold sores in the mouth, throat, or tongue are best treated with topical cortisone gel or rinse. Less commonly, injecting cortisone directly into accessible lesions is effective.
HEART MURMURS IN CHILDREN: The American Academy of Family Physicians recommends children found to have heart murmurs that seem to be pathologic (caused by an abnormality of the heart), be referred to a pediatric cardiologist before any other testing is done. This is not the option I would choose, however. The ordering and interpretation of an echocardiogram is routine in family practice, even for children. If the echo is normal, the patient and family will avoid an expensive and unnecessary visit to a specialist and can be followed to observe for a change in status.
ASPIRIN FOR PREVENTING HEART DISEASE IN WOMEN: There’s no debate about the benefits of low-dose aspirin for the prevention of recurrent cardiovascular events in women with a prior event. It should be taken! However, for primary prevention in patients without prior events, low-dose aspirin should be given to women aged 40-59 years who have a 10%, or greater, 10-year risk of a CV event. Also women aged 60-69 with a 20%, or greater, 10-year risk and diabetics with a 10%, or greater 10-year risk, should take low-dose aspirin. This is not new info. I’ve presented it in the past. The bottom line is: If you’re female, diabetic, smoke, and have a family history of heart disease, you should take low-dose aspirin every day.
TREATMENT FOR SEVERE HAIR LOSS: Alopecia areata is patchy, non-male pattern baldness occurring in all age groups. It causes round or oval bald patches, and is thought to be an auto-immune disorder. There now exists a “systemic treatment” that has great promise. Olumiant (baricitinib), an oral drug, blocks the action of enzymes that cause inflammation, the mechanism suspected of causing patchy hair loss. The goal of treatment was to achieve at least 80% hair growth after 36 weeks, about 9 months, of treatment. Compared to placebo, one-fifth of those receiving 2 mg and one-third of those receiving 4 mg reached that goal. It costs $2500.00 a month, and it can cause upper respiratory infections, acne, headache, and shingles. Doctors and patients are warned to use it cautiously.
References: Shufelt CL, Mora S, Manson JE. Aspirin for the Primary Prevention of Atherosclerotic Cardiovascular Disease in Women. JAMA 2022 Aug 16;328(7):672-673.
AFP Clinical Answers AmFamPhys 2022 August;106(2):130.
News from the Food and Drug Administration. “First Systemic Treatment for Severe Alopecia is Approved,” JAMA 2022 July 19;328(3):235.
