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BACTERIURIA, ASYMPTOMATIC
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Nonpregnant women with asymptomatic bacteriuria.
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– Do not treat asymptomatic bacteriuria with antibiotics.
– Do not screen pediatric patients for asymptomatic bacteriuria.
– Only screen pregnant women and patients undergoing urologic procedures.
– Treat asymptomatic bacteriuria in pregnant patients for 4–7 d.
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Practice Pearl
Delirium in older patients is often caused by urinary tract infections. However, in the absence of overt urinary symptoms or signs of systemic infection, empiric treatment of bacteriuria does not improve patient-oriented outcomes. (JAMA Intern Med. 2019;179(11):1519-1527)
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Healthy adults (without chronic lung disease or immunocompromising conditions) with the common cold.
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► Annals of Internal Medicine 2016
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Practice Pearls
Harm from antibiotics outweighs benefits, as all causes of common cold are viral.
Evidence-based therapies for cold symptoms include the following:
- Ipratropium (4 puffs QID) for cough.
- NSAIDs for headache, earache, muscle, and joint pains.
- Acetaminophen for rhinorrhea.
- Decongestants, with or without antihistamines, for congestion.
- Zinc (80–92 mg/d within 3 d of symptom onset) to reduce duration.
- Honey, in children.
Nasal saline, oral fluid intake, nasal oxymetazoline, and many herbal therapies lack quality evidence of efficacy.
Therapies proven to be no more effective than placebo include antibiotics, antivirals, antihistamines, cough suppressants and expectorants, nasal steroids, steam, vitamins D and E, and echinacea.
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CORONAVIRUS DISEASE 2019 (COVID-19)
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► CDC 2022, WHO 2021, WHO 2022, IDSA 2022, ACP 2023
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– Offer symptomatic management including antipyretics, analgesics, and antitussives, encourage adequate nutrition and rehydration.
– Consider educating about breathing exercises.
– Counsel about signs and symptoms that warrant urgent medical care.
– Monoclonal antibody therapy: If at risk for progression to severe disease, offer monoclonal antibody therapy. See Tables 26–1 and 26–2 for risk tiers and comorbid conditions that elevate risk.
CDC: use one of the following, listed in order of preference: ritonavir-boosted nirmatrelvir, sotrovimab, remdesivir, molnupiravir.
WHO: use casirivimab, imdevimab, or sotrovimab.
– In patients with mild-to-moderate COVID-19 at high risk for progression to severe, give nirmatrelvir/ritonavir within 5 d of symptom onset (300-mg nirmatrelvir/100-mg ritonavir BID × 5 d, GFR 30–60 mL/min/1.73 m2 150 mg/100 mg BID ×5 d, GFR <30 mL/min/1.73 ...