Tools for Practice

Tools for Practice #364 Facing the Evidence in Acne, Part II: Oral Antibiotics

How effective are oral antibiotics in treating acne of at least mild-moderate severity?

Approximately 17% of patients achieve “success” on oral minocycline versus 9% on placebo at 12 weeks. Oral antibiotics reduce acne lesion count by 10-24% more than placebo. Evidence of the efficacy of adding oral antibiotics to topical agents (example: retinoids, benzoyl peroxide) is limited. Efficacy appears similar between individual antibiotics. Discontinuations due to adverse events are comparable to placebo. Read More

Tools for Practice #363 Making a difference in indifference? Medications for apathy in dementia

In patients with dementia, how safe and effective are stimulants, antidepressants, and antipsychotics for treating apathy?

Methylphenidate may improve apathy scores by a small but potentially clinically meaningful amount compared to placebo (example: 5 points more on a 72-point scale) at ~12 weeks. Methylphenidate does not impact cognition in randomized, controlled trials (RCTs). Antipsychotics and antidepressants do not improve apathy compared to placebo. Read More

Tools for Practice #362 – Facing the Evidence in Acne, Part I: Oral contraceptives and spironolactone in females

How effective are combined oral contraceptives (COC) and spironolactone for treating acne of at least mild-moderate severity in females?

At ~24 weeks, ~80-90% of females report improvement in their acne with COCs, compared to 50-80% placebo, and 30-50% will have clear-almost clear skin versus 10-40% on placebo. Efficacy appears similar between individual COCs. Spironolactone, typically added to topical agents, has similar outcomes. Discontinuations due to adverse events appear comparable to placebo. Read More

Tools for Practice #361 Preventing RSV Infections in Infants

How safe and effective are monoclonal antibodies to prevent respiratory syncytial virus (RSV) infections in infants?

In high-risk infants (premature and/or congenital heart or lung conditions), palivizumab (4-5 doses monthly during RSV season) reduces RSV hospitalization (4.5% versus 10% placebo). Nirsevimab (one dose) reduces RSV hospitalizations in healthy premature infants (0.8% versus 4%) and term infants (0.3-0.4% versus 1.5-2.0%). Side effects are similar to placebo. Read More

Tools for Practice #360 Ketamine for Depression

What are the benefits and harms of ketamine/esketamine for depression?

Ketamine/esketamine appears effective for moderate-severe depression (helping 10-20% more people respond over placebo at 1-4 weeks). However, biases are very common and large effects are likely exaggerated. Adverse events are common (example: 20% more nausea/vomiting). Considerable uncertainty remains (treating mid/long-term, misuse risk, and long-term harms) and treatment is costly. Read More