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Mar 28 โ€ข 7 tweets โ€ข 8 min read
THREAD: How best to treat Urinary Tract Infections?

1/6 Our new TI Therapeutics Letter 135 describes the best approach for treating symptomatic, uncomplicated lower urinary tract infections (UTIs)

๐Ÿ‘‰๐Ÿฝti.ubc.ca/letter135

#MedEd #FOAMed #UTIs #BetterPrescribing
2/6 Use symptoms, not tests to diagnose UTIs:

Uncomplicated lower UTI can be diagnosed with > 90% probability if pt has 2 or more of dysuria, urgency, and frequency, and no vaginal discharge.

This is less reliably predicted for older women.

๐Ÿ‘‰๐Ÿฝti.ubc.ca/letter135

#MedEd
3/6 No need to culture:

โœ…Fewer than 2% of urine cultures meaningfully impact choice of treatment or need for follow-up
โœ…Most guidelines recommend against culture for
symptomatic uncomplicated #UTIs

๐Ÿ‘‰๐Ÿฝti.ubc.ca/letter135

#MedEd #BetterPrescribing #BetterHealth
4/6 Best choice for uncomplicated UTI?

Nitrofurantoin for 5-7 days provides best combination of:

โœ…Clinical effectiveness
โœ…Low bacterial resistance
โœ…Infrequent adverse events

๐Ÿ‘‰๐Ÿฝti.ubc.ca/letter135

#MedEd #BetterPrescribing #BetterHealth
5/6 Conclusions on treating uncomplicated lower urinary tract infections:

Read Full letter here: ti.ubc.ca/letter135

#MedEd #BetterPrescribing #antibiotics
6/6 BC Family Physicians, your #PrescribingPortrait is NOW available at Portrait Online:

โœ…Read our new Prescribing Portrait on tx of UTIs: bit.ly/3IKjsdt

โœ…Sign up + learn more about how Portrait Online can support #BetterPrescribing: ti.ubc.ca/portrait
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More from @Drug_Evidence

Feb 28
THREAD: Bring it down safely! โ†˜๏ธ๐Ÿ’Š

1/6 6โƒฃtweets about our new TI Therapeutics Letter 134: Finding the lowest effective dose for non-opioid #analgesics

๐Ÿ‘‰๐Ÿพ Full Letter: ti.ubc.ca/letter134

#MedEd #medsafety #prescribing #BetterPrescribing Image
2/6 Consistent evidence that minority of pts get clinically meaningful pain relief from any dose of:
โœ…#Cyclobenzaprine (at best 1/4)
โœ…#Duloxetine (at best 1/6)
โœ…#Gabapentin / #Pregabalin (at best 1/6)

๐Ÿ‘‰๐Ÿพti.ubc.ca/letter134

#MedEd #ptsafety #BetterPrescribing #prescribing Image
3/6 Gabapentin, pregabalin, duloxetine:

A 2021 Canadian systematic review found NNT (numbers needed to treat) of 6-7 for "clinically meaningful benefit" (defined as โ‰ฅ30% reduction in pain or pain & function)

๐Ÿ‘‰๐Ÿพti.ubc.ca/letter134

#MedEd #BetterPrescribing #deprescribing Image
Read 7 tweets
Feb 2
THREAD: Primary #hypertension therapy: after thiazides, an ACEI or an ARB?

1/8 Nearly 650,000 British Columbians took an ACEI or ARB in 2021

Our new TI Therapeutics Letter reiterates evidence for one of the most common primary care tx choices: ti.ubc.ca/letter133

#MedEd
2/8 Lower #BloodPressure not the Main Goal

#Antihypertensives lower various measures of blood pressure (BP) ๐Ÿ’Š

But... not all BP lowering drugs are proven to reduce both morbidity & mortality

๐Ÿ‘‰๐Ÿพti.ubc.ca/letter133

#MedEd #prescribing #hypertension
3/8 The importance of clinical outcomes

Basing decisions on which drug lowers #BloodPressure the best cannot guarantee the best clinical outcomes

Read our Therapeutics Letter on optimal 1st and 2nd line treatments: ti.ubc.ca/letter133

#MedEd #prescribing #hypertension
Read 9 tweets
Jan 21
THREAD: #ExercisePrescriptions

1/5 The TIโ€™s Dr. Josh Levin asks:

Clinicians, can you help your patients be more active? ๐Ÿƒ๐Ÿพโ€โ™€๏ธ๐ŸŠ๐Ÿพโ€โ™‚๏ธ ๐Ÿšถ๐Ÿพโ€โ™‚๏ธ

๐Ÿ‘‰๐ŸพWatch Dr. Levinโ€™s recent presentation: bit.ly/3nLCEje ๐Ÿ‘จ๐Ÿพโ€๐Ÿ’ป

#Exercise #prescribing #twitterRx
2/5 #ExercisePrescriptions: How much activity should people get? It depends on their age.

๐Ÿ‘‰๐ŸพSee the Canadian Society for Exercise Physiology activity guidelines for different age groups: csepguidelines.ca ๐ŸŠ๐Ÿพโ€โ™‚๏ธ๐Ÿƒ๐Ÿพโ€โ™€๏ธ๐Ÿšถ๐Ÿพ

#Exercise #prescribing #twitterRx #BetterHealth
3/5 Below is an example of an #ExercisePrescription ๐ŸŠ๐Ÿพโ€โ™‚๏ธ๐Ÿƒ๐Ÿพโ€โ™€๏ธ๐Ÿšถ๐Ÿพโ€โ™‚๏ธ

#Exercise #prescribing #twitterRx #BetterPrescribing
Read 6 tweets
Nov 27, 2021
THREAD: SGLT2 inhibitors for #diabetes

1/5 Dr. Jamie Falk @jamisonfalk presented "A Deep Dive into #SGLT2i: What Comes to the Surface for Individuals with Diabetes"

๐Ÿ‘‰๐ŸฝWatch the presentation here: bit.ly/3FRCEoM ๐Ÿง‘๐Ÿพโ€๐Ÿ’ป

#T2DM #medsafety #FOAMed #MedEd
2/5 #AdverseEffects for #SGLT2i to be aware of: genital infections, hypovolemia, DKA, amputations

โœ…Check out the image โฌ‡๏ธ for the risk estimates
โœ…Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM๐Ÿง‘๐Ÿพโ€๐Ÿ’ป

#T2DM #medsafety #FOAMed #MedEd #diabetes #ptsafety
3/5 Evidence to date for #SGLT2i:

The first of the two new classes of medications for type II diabetes to reduce โ†˜๏ธ risk of CV #AdverseEvents and mortality

โœ…Watch @JamisonFalk's presentation here: bit.ly/3FRCEoM๐Ÿง‘๐Ÿพโ€๐Ÿ’ป

#T2DM #medsafety #FOAMed #MedEd #diabetes
Read 6 tweets
Nov 10, 2021
THREAD: Evidence for oseltamivir for #influenza prevention

1/6 Not much #flu last year, yet almost 14,000 BC residents were prescribed #oseltamivir (Tamiflu) for prevention

โœ…Flu guidelines bit.ly/3wwGJei

โœ…Systematic review of Tamiflu safety pubmed.ncbi.nlm.nih.gov/27246259
2/6 #Oseltamivir for prevention reduces โ†˜๏ธ symptomatic influenza by 3%, (NNT=33) with an uncertain effect on asymptomatic #influenza

It likely has a central symptom reducing effect but may not reduce viral transmission
pubmed.ncbi.nlm.nih.gov/27246259

#Tamiflu #prescribing
3/6 #Oseltamivir wonโ€™t reduce the risk of developing influenza-like illness though it can make people feel better (i.e. fewer symptoms) and reduces โ†˜๏ธ fever

There is not enough evidence to say it prevents death, hospitalizations, or flu complications
pubmed.ncbi.nlm.nih.gov/27246259
Read 7 tweets
Sep 19, 2021
THREAD: Medication adherence and shared decision-making

1/6 Our TI Letter 132 suggests a more democratic & ethical approach to shared decision-making: ti.ubc.ca/letter132

Here are 5โƒฃ highlightsโ€ฆ

#MedEd #FOAMed #MedicationAdherence #PatientPreferences
2/6 Patients always retain right to say โ€œno, thank youโ€๐Ÿ›‘

Some pts may not want to accept their doctor's recommendations for a prescribed ๐Ÿ’Š & have their own reasons to feel that it's not worth it for them.

This "intentional non-adherence" is a choice that should be respected
3/6 Studies have tested adherence aids

While these aids can improve adherence we donโ€™t know if they lead to improved health outcomes ๐Ÿ˜•

See our TI Letter 132 on medication adherence: ti.ubc.ca/letter132 ๐Ÿ’ป

#MedEd #FOAMed #MedicationAdherence #PatientPreferences
Read 7 tweets

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