-Parere degli esperti -Pubblicazioni -Esperienza clinica -Adeguamento della

-Parere degli “esperti” -Pubblicazioni -Esperienza clinica -Adeguamento della terapia al singolo paziente

Prima di far praticare un esame, bisogna chiedersi quale sarà l'atteggiamento: a) se il risultato è positivo b) se il risultato è negativo. Se nei due casi l'atteggiamento previsto è identico, l'esame non va richiesto Archibald Cochrane: L'inflazione medica. Efficacia ed efficienza in medicina prima edizione 1972

- acetaminophen, chlorpheniramine, dextromethorphan, pseudoephedrine - Pseudoephedrine, phenylpropanolamine, dextromethorphan, - phenylpropanolamine, brompheniramine

Antibiotics for acute maxillary sinusitis (Cochrane Review) Williams Jr. JW, Aguilar C, Makela M, Cornell J, Hollman DR, Chiquette E, Simel DL Reviewers' conclusions: For acute maxillary sinusitis confirmed radigraphically or by aspiration, current evidence is limited but supports penicillin or amoxicillin for 7 to 14 days. Clinicians should weigh the moderate benefits of antibiotic treatment against the potential for adverse effects. Decongestants and antihistamines for acute otitis media in children (Cochrane Review) Flynn CA, Griffin G, Tudiver F Reviewers' conclusions: Given lack of benefit and increased risk of side effects, these data do not support the use of decongestant, antihistamine, or combined DC/AH treatment in children with AOM. The small statistical benefit found in the combination medication group is of small clinical significance and study design may be biasing the results.

Nasal decongestants for the common cold (Cochrane Review) Taverner D, Bickford L, Draper M Reviewers' conclusions: A single dose of nasal decongestant in the common cold is moderately effective for the short term relief of congestion in adults, while there is no evidence available to show benefit after repeated use over several days. These medications are not recommended for use in young children with the common cold. Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children (Cochrane Review) Butler CC, van der Voort JH Reviewers' conclusions: There is evidence that steroids combined with an antibiotic lead to a quicker resolution of OME in the short term. However, there is not evidence for long term benefit from treating hearing loss associated with OME with either oral or topical nasal steroids. These treatments are therefore not recommended at the present time. Future studies should document hearing loss associated with OME before the start of study treatment. Follow up should be longer and ideally include symptom, audiometry and developmental outcomes.

Vaccines for preventing influenza in people with asthma (Cochrane Review) Cates CJ, Jefferson TO, Bara AI, Rowe BH Reviewers' conclusions: There is not enough evidence to assess the benefits and risks of influenza vaccination for people with asthma. Pneumococcal vaccine for asthma (Cochrane Review) Sheikh A, Alves B, Dhami S. Reviewers' conclusions: This review found very limited evidence to support the routine use of pneumococcal vaccine in people with asthma. A randomised trial of vaccine efficacy in children and adults with asthma is needed.

Echinacea for preventing and treating the common cold (Cochrane Review) Melchart D, Linde K, Fischer P, Kaesmayr J Reviewers' conclusions: The majority of the available studies report positive results. However there is not enough evidence to recommend a specific Echinacea product, or Echinacea preparations for the treatment or prevention of common colds. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes (Cochrane Review) Vickers AJ, Smith C. Reviewers' conclusions: Oscillococcinum probably reduces the duration of illness in patients presenting with influenza symptoms. Though promising, the data are not strong enough to make a general recommendation to use Oscillococcinum for firstline treatment of influenza and influenza-like syndrome. Further research is warranted but required sample sizes are large. Current evidence does not support a preventative effect of homeopathy in influenza and influenza-like syndromes.

Antibiotics for acute bronchitis (Cochrane Review) Smucny J, Fahey T, Becker L, Glazier R Reviewers' conclusions: Overall, antibiotics appear to have a modest beneficial effect in patients who are diagnosed with acute bronchitis. The magnitude of this benefit, however, is similar to that of the detriment from potential adverse effects. Furthermore, patients with other symptoms of the common cold who have been ill for less than one week are not likely to have any benefit from antibiotics. Chest radiograph in acute respiratory infections in children (Cochrane Review) Swingler GH, Zwarenstein M Reviewers' conclusions: There is no evidence that chest radiography improves outcome in ambulatory children with acute lower respiratory infection. The findings do not exclude a potential effect of radiography, but the potential benefit needs to be balanced against the hazards and expense of chest radiography. The findings apply to ambulatory children only.

Beclomethasone for asthma in children: effects on linear growth (Cochrane Review) Sharek PJ, Bergman DA, Ducharme Reviewers' conclusions: In children with mild-moderate asthma, beclomethasone 200 mcg twice daily caused a decrease in linear growth of -1. 54 cm per year. These studies lasted a maximum of 54 weeks, so it remains unclear whether the decrease in growth is sustained or whether it reverses with 'catch up' after therapy is discontinued. We are unable to comment on growth effects of other inhaled steroids that have potentially less systemic effects. If inhaled steroids are required to control a child's asthma, we recommend using the minimum dose that effectively controls the child's asthma and closely following growth Inhaled beclomethasone versus placebo for chronic asthma (Cochrane Review) Adams NP, Bestall JB, Jones PW Reviewers' conclusions: This review has quantified the efficacy of BDP in the treatment of chronic asthma and strongly supports its use. Current asthma guidelines recommend titration of dose to individual patient response, but the published data provide little support for dose titration above 400 mcg/d in patients with mild to moderate asthma. There are insufficient data to draw any conclusions concerning dose-response in patients with severe disease.

Heated, humidified air for the common cold (Cochrane Review) Singh M. Reviewers' conclusions: Three trials demonstrated beneficial effects on the symptoms of the common cold. One study from Israel showed a decrease in nasal resistance measured by peak nasal expiratory and inspiratory flow rate. Studies done in North America failed to show any objective improvement in outcome measures with the study intervention. A multi-centre double blind randomised controlled trial testing this therapy with uniform outcome measures is recommended House dust mite control measures for asthma (Cochrane Review) Gøtzsche PC, Johansen HK, Burr ML, Hammarquist C Reviewers' conclusions: Currently available evidence from controlled trials of chemical and physical approaches to reducing exposure to house dust mite antigens in the homes of mitesensitive asthmatics does not provide a secure basis for advice and policy. Further trials – one of them very large - are currently in progress. The additional evidence from these studies will help to clarify whether or not the substantial efforts required to implement strategies intended to reduce mites can be expected to yield beneficial effects of a magnitude that people with mite sensitive asthma consider worthwhile.

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