Acute Otitis Externa, Fibromyalgia, Major Depressive Disorder, Hyperkalemia, Osteoporosis, Corticosteroids During Pregnancy, Trigger Point Pain
Am Fam Physician. 2023;107(6):578
When should systemic antibiotics be considered for treatment of acute otitis externa?
Systemic antibiotics should be used only if the infection has spread beyond the ear canal or in patients at high risk of worsening infection, such as those who are immunocompromised or have uncontrolled diabetes mellitus.
What medications may be helpful in the treatment of fibromyalgia pain?
Amitriptyline, cyclobenzaprine, duloxetine (Cymbalta), milnacipran (Savella), and pregabalin (Lyrica) are effective for pain in fibromyalgia.
Is pharmacogenomic-guided antidepressant treatment beneficial in the management of major depressive disorder in adults?
Based on a randomized controlled trial of 1,944 patients, pharmacogenomic testing for drug-gene interactions in adults with major depressive disorder resulted in reduced prescribing of medications with potential drug-gene interactions. However, there was no significant difference in symptom remission rates between the gene-tested group and the usual care group at six months.
Which oral potassium binders can be considered for initial treatment of hyperkalemia?
Patiromer (Veltassa) or sodium zirconium cyclosilicate (Lokelma) is preferred to sodium polystyrene sulfonate in patients with chronic hyperkalemia due to higher efficacy and lower risk of serious adverse effects.
How long should a patient with osteoporosis take bisphosphonates?
A drug holiday should be considered in patients who have received oral bisphosphonate therapy for five years or intravenous bisphosphonate therapy for three years.
Are topical corticosteroids safe during pregnancy?
Low- to midpotency topical corticosteroids are not associated with adverse pregnancy outcomes.
What initial steps can be considered for management of trigger point pain?
Massage and physical therapy should be considered as less invasive first-line treatments for trigger point pain. The routine use of trigger point injections is not supported by clinical trials.
Additional Online Only AFP Clinical Answers
When should patients with hip fractures undergo surgical repair?
Operative management of a hip fracture should occur within 24 to 48 hours of injury unless a delay is needed to stabilize comorbidities. Early operative management improves pain control, decreases length of hospitalization, and reduces complications.
When can patients with infectious mononucleosis return to sports?
Individuals with infectious mononucleosis should not participate in athletic activity for three weeks following symptom onset to decrease the risk of splenic rupture, beginning with light, noncontact exercise. Athletes should return only when they feel clinically well and are afebrile. Shared decision-making should be used to determine the timing of return to sports. There is no strong evidence to support the use of ultrasonography in expediting the patient's return to sports.
Unless history of exposure or symptoms consistent with Lyme disease are present, routine testing for Lyme disease in the setting of musculoskeletal symptoms is not recommended.
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