AFP Pearls

I read the American Family Physician journal, sent to all members of the American Academy of Family Physicians and anyone else who subscribes, and sometimes an issue comes out with a few pearls that I want to pass on. The Oct 15, 2016 edition was one of them and here are a few of the tidbits of wisdom I’m sharing from this issue today:

     –TRAVELERS DIARRHEA UPDATE:  Traveler’s diarrhea is the most common infection in international travelers.  It can occur in 30-70% of travelers in some areas.  Despite the universal advice to avoid food from street vendors, don’t drink tap water, avoid raw foods and ice there is evidence that these precautions have not been shown to reduce the incidence of travelers diarrhea.  Although a short course of ciprofloxacin has been the usual recommendation (500 mg initial dose followed by 500 mg 12 hours later) there are reasons that this may no longer be optimal.  First resistance to this class of antibiotics is high in some areas, especially in Campylobacter infections in SE Asia.  Second is the FDA warning to limit fluoroquinolone use due to side effects risk. Azithromycin is also effective at a dose of 500 mg daily for 1-3 days, or as a single 1000 mg dose. It may now be the best recommendation worldwide. 

     -TWO GOOD PLACES TO FIND MALARIA PROPHYLAXIS INDORMATION:  Advice for Malaria prophylaxis is available on the CDC site or from the WHO Malaria information web page.

     -SPECIFIC GENERIC INEXPENSIVE BIRTH CONTROL PILLS ARE SAFER THAN SOME NEW EXPENSIVE BRAND NAME OPTIONS:   In a huge French study of the use of ischemic stroke, heart attack and pulmonary embolism with birth control pill use came good news.  First as has been previously shown the risks are very low, roughly 6 per 10,000 women.  Not just that but the risks are lowest with the lowest dose estrogen pills, i.e. 20 mcg.  Not only that but the specific progestin used makes a difference, and the older, generally less expensive oral contraceptive ingredient levonorgestrel is associated with the lowest risk.  Newer progestins used in the considerably more expensive branded birth control pills specifically desogestrel (in Desogen and Mircette) and gestodene (in Gynera, Femogen, and others).  The lowest risk was in  pills using 20 mcg estrogen and levonorgestrel.   Examples are Alesse, Aviane, Lessina, Levlite, and Lutera all of which have 20 mcg. of ethinyl estradiol and 0.1 mg of levonorgestrel.  Although some women may have breakthrough bleeding on these fixed dose birth control pills, they seem like the optimal first choice option for many women who choose a daily use pill for contraception.  (A caveat to this report is that some types of birth control pills were not looked at because they were not used in the French national health formulary.)

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