Prescrire international
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Prescrire international · Apr 2014
ReviewTreating blood pressure between 140/90 and 160/95 mmHg: no proven benefit.
According to a systematic review of four randomised trials in 8912 patients, antihypertensive therapy has not been shown to have a positive harm-benefit balance in people with blood pressure between 140/90 mmHg and 159/99 mmHg, but with no other cardiovascular risk factors.
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Prescrire international · Feb 2014
ReviewGlycopyrronium for inhalation. COPD: another antimuscarinic with cardiac adverse effects that require monitoring.
The most effective way of slowing chronic obstructive pulmonary disease (COPD) progression is to eliminate exposure to the inhaled triggering factor, which is usually tobacco smoke. At best, inhaled bronchodilators have only a limited impact on the symptoms of COPD. In the absence of a better alternative, salbutamol, a beta-2 agonist, or ipratropium, an antimuscarinic, are tried first, despite their adverse effects. "Long-acting" beta-2 agonists are an option for patients with permanent symptoms, especially dyspnoea that disrupts sleep. ⋯ The inhaler is simple to use and does not require hand-breath coordination. In practice, glycopyrronium does not provide a therapeutic advantage in the treatment of patients with COPD. When an inhaled long-acting drug is contemplated, it is best to choose a beta-2 agonist (formoterol or salmeterol), used either continuously or on demand.
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Prescrire international · Feb 2014
ReviewRecurrent uncomplicated cystitis in women: allowing patients to self-initiate antibiotic therapy.
Acute uncomplicated cystitis is a lower urinary tract infection occurring in the absence of anatomic or functional abnormalities of the urinary tract or any other complicating factors. The organism responsible is often an enterobacterium, especially Escherichia coli. What is the role of antibiotic therapy for non-pregnant women with recurrent acute uncomplicated cystitis? We reviewed the available evidence using the standard Prescrire methodology. ⋯ In practice, the strategy that uses the fewest antibiotics is to treat each episode as soon as the first clinical symptoms appear. Cases in which the frequency of recurrence warrants regular antibiotic prophylaxis are rare. The optimal antibiotic regimen in these cases has not been determined, either in clinical trials or by consensus.