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ASYMPTOMATIC BACTERIURIA

Population

  • –Nonpregnant women.

Recommendation

IDSA 2015

  • –Do not treat asymptomatic bacteriuria with antibiotics.

Source

COMMON COLD

Population

  • –Healthy adults (those without chronic lung disease or immunocompromising conditions).

Recommendation

Annals of Internal Medicine 2016

  • –Do not prescribe antibiotics for the common cold.

Source

Comment

  1. Harm from antibiotics outweigh benefits as all causes of common cold are viral.

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Population

  • –HIV-infected adults and children.

Recommendations

IDSA 2013

  • –Obtain a comprehensive present and past medical history, physical examination, medication/social/family history, and review of systems, including HIV-related information upon initiation of care.

  • –Educate patient on high-risk behaviors to minimize risk of HIV transmission.

  • –Assess for the presence of depression, substance abuse, or domestic violence.

  • –Baseline labs upon initiation of care: HIV serostatus; CD4 count; quantitative HIV RNA by PCR (viral load); HIV genotyping; CBCD, chemistry panel, G6PD testing; fasting lipid profile; HLA B5701 test (if abacavir will be used); tropism testing (if the use of a CCR5 antagonist is being considered); urinalysis; Pap smear in women.a

  • –Screening labs: M. tuberculosis testing (PPD or interferon-γ release assay); Toxoplasma antibodies; Hepatitis B panel, HCV antibodies; VDRL; urine NAAT for gonorrhea; and urine NAAT for chlamydia (except in men age <25 y); anti-CMV IgG in lower risk groups (populations other than men who have sex with men or IV drug users), trichomoniasis in all women, Chlamydia trachomatis in all women ≤25 y of age.

  • –Monitoring labs:

    • CD4 counts and HIV viral load every 3–4 mo.

    • STD screening and TB screening tests should be repeated periodically depending on symptoms and signs, behavioral risk, and possible exposures.

    • Fasting glucose and lipid panel 4–6 wk after initiation of therapy.

  • –Vaccination for pneumococcal infection, influenza, varicella, hepatitis A, and HBV according to standard immunization charts.

  • –All HIV-infected women of childbearing age should be asked about their plans and desires regarding pregnancy upon initiation of care and routinely thereafter.

  • –Pap smear in women every 6 mo and annually thereafter if results are normal

  • –Perform individualized assessment of risk for breast cancer and inform them of the potential benefits and risks of screening mammography for women ages 40–49 y. Perform mammogram annually for age >50 y.

  • –Hormone replacement therapy is not recommended.

Source

  • –Aberg JA, Gallant JE, Ghanem KG, Emmanuel P, Zingman BS, Horberg MA. Primary care guidelines for the management of persons infected with HIV: 2013 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58(1):e1-e34, http://academic.oup.com/cid/article/58/1/e1/374007#74163693

Comments

  1. Screen for anogenital human papilloma virus (HPV) and anal Pap testing for homosexual men and women ...

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