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The USPSTF recommends that clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco.
U.S. Preventive Services Task Force A and B recommendations
U.S. Preventive Services Task Force
Recommendation grade A
ver más ... 2015Don’t prescribe aminoglycosides for synergy to patients with bacteremia or native valve infective endocarditis caused by Staphylococcus aureus.
Choosing Wisely Canada
Medical Microbiology and Infectious Disease
The addition of an aminoglycoside such as gentamicin to beta-lactam therapy or vancomycin for treatment of bacteremia or native valve infective endocarditis caused by Staphylococcus aureus has not been demonstrated to improve clinical outcomes. This practice may result in adverse effects including acute kidney injury and ototoxicity. The addition of gentamicin is still recommended in cases of prosthetic valve endocarditis caused by Staphylococcus aureus.
ver más ... 2015Don’t routinely repeat radiologic imaging in patients with osteomyelitis demonstrating clinical improvement following adequate antimicrobial therapy.
Choosing Wisely Canada
Medical Microbiology and Infectious Disease
There is poor correlation between clinical response and resolution of findings on magnetic resonance imaging (MRI), computed tomography (CT), and nuclear studies in patients with osteomyelitis. Because radiologic resolution may lag behind clinical improvement, repeat imaging may lead to unnecessary prolongation of antimicrobial therapy. Repeat imaging is indicated in cases where there is a lack of clinical response, progression of clinical findings, or the presence of an undrained abscess on ...
ver más ... 2015Don’t routinely repeat CD4 measurements in patients with HIV infection with HIV-1 RNA suppression for >2 years and CD4 counts >500/µL, unless virologic failure occurs or intercurrent opportunistic ...
Choosing Wisely Canada
Medical Microbiology and Infectious Disease
The 2014 recommendations of the International Antiviral Society – US Panel state that measurement of CD4 count is optional among patients with suppressed viral loads for >2 years and CD4 counts >500/µL. CD4 measurement in these patients is of low-value and may create unnecessary patient concern in response to normal variation of CD4 counts. In prospective studies of patients who have responded to antiretroviral therapy with HIV-1 RNA suppression and rises in CD4 cell count >200 cells/μL, ...
ver más ... 2015Don’t prescribe alternate second-line antimicrobials to patients reporting non-severe reactions to penicillin when beta-lactams are the recommended first-line therapy.
Choosing Wisely Canada
Medical Microbiology and Infectious Disease
Reported penicillin reactions frequently result in the use of alternate second-line agents that may be clinically inferior or may pose increased risks to patients resulting in longer lengths of stay and increased costs of care. Alternate broad-spectrum agents may also result in increased rates of adverse events and selection for antimicrobial resistance. Therefore, it is important to obtain a detailed history of a patient’s reported prior reaction to penicillin to determine whether ...
ver más ... 2015