Alzheimer Disease, Chronic Cough, Alopecia, Mild Traumatic Brain Injury, Cushing's Syndrome, Uncomplicated Febrile UTI
Am Fam Physician. 2024;110(6):571
Does brexpiprazole (Rexulti) reduce agitation in adults with Alzheimer disease and agitated behaviors?
In a randomized, double-blind, industry-funded trial of 345 patients with Alzheimer disease and agitated behaviors, brexpiprazole modestly reduced agitation scores and was well tolerated.
What pharmacologic therapy may be used to treat chronic refractory cough?
A trial of a neuromodulator, such as gabapentin or amitriptyline, should be considered for chronic refractory cough when the underlying etiology is cough hypersensitivity.
How should chronic cough be evaluated and treated?
In adults, evaluation and treatment of chronic cough should be based on the most common causes, including upper airway cough syndrome, asthma, nonasthmatic eosinophilic bronchitis, gastroesophageal reflux disease (GERD), and laryngopharyngeal reflux. In children, the most common causes include protracted bacterial bronchitis, asthma, bronchiectasis, upper airway cough syndrome, and GERD.
What is the recommended treatment for androgenetic alopecia?
Topical minoxidil is effective for the treatment of adults with androgenetic alopecia. Oral finasteride can be used as first-line treatment or with topical minoxidil therapy for male patients.
What are current clinical practice guidelines for imaging in children with acute mild traumatic brain injury (mTBI)?
In children with acute mTBI (ie, concussion), a systematic review suggests that computed tomography of the head should be considered only for those with severe headache or worsening symptoms, or when a head or neck injury is suspected. Radiography of the skull does not have a role in the management of mTBI, and routine imaging is not supported by high-quality evidence.
What is the recommended evaluation for Cushing's syndrome?
The recommended screening tests for hypercortisolism are 24-hour urinary free cortisol, late-night salivary cortisol, and 1-mg dexamethasone suppression tests.
Does a reduced duration of antibiotics to treat uncomplicated febrile urinary tract infection (UTI) result in similar outcomes as a longer duration?
A randomized controlled trial with 142 children aged 3 months to 5 years with uncomplicated febrile UTI found that 5 days of antibiotic treatment results in similar symptom resolution and 30-day recurrence rates as 10 days of treatment.
Additional Online Only AFP Clinical Answers
What is the recommended treatment for adult attention deficit/hyperactivity disorder (ADHD)?
Stimulants are first-line pharmacologic therapy for adult ADHD. Nonstimulant medications (eg, atomoxetine, viloxazine [Qelbree], bupropion) are indicated when stimulants are contraindicated, not tolerated, or ineffective. Recommended nonpharmacologic therapies include cognitive behavior therapy, mindfulness, dialectical behavior therapy, and hypnotherapy.
What is the recommended treatment for alcohol use disorder?
For alcohol use disorder treatment and relapse prevention, consider prescribing a noncontrolled opioid antagonist, such as daily oral naltrexone (Revia) or monthly extended-release intramuscular naltrexone (Vivitrol). Acamprosate, taken orally two or three times daily, is also considered a first-line treatment.
When are pharmacologic therapies for obesity recommended?
Pharmacologic therapies for obesity are indicated with lifestyle measures and should be offered to nonpregnant patients with a body mass index ≥ 30 kg/m2 and to those with a body mass index ≥ 27 kg/m2 with metabolic comorbidities, including hypertension, type 2 diabetes, or dyslipidemia.
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