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Objective To predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated urinary tract infection (UTI). Setting 16 sites in a primary care setting in Norway, Sweden and Denmark. Participants Data from 181 non-pregnant women aged 18–60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen. Methods Using the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics. Results Of the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0–6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74). Conclusion We did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the current evidence for the efficacy of corticosteroid injection and nonelectrotherapeutic physiotherapy compared with control for treating lateral epicondylitis. Design: Systematic review. Participants: We searched five databases in September 2012 for randomised controlled studies with a minimum quality rating. Of the 640 studies retrieved, 11 were included, representing 1161 patients of both sexes and all ages. Interventions: Corticosteroid injection and nonelectrotherapeutic physiotherapy. Outcome measures: Relative risk (RR) or standardised mean difference (SMD) for overall improvement, pain and grip strength at 4-12, 26 and 52 weeks of follow-up. Results: Corticosteroid injection gave a short-term reduction in pain versus no intervention or nonsteroidal anti-inflammatory drugs (SMD -1.43, 95% CI -1.64 to -1.23). At intermediate follow-up, we found an increase in pain (SMD 0.32, 95% CI 0.13 to 0.51), reduction in grip strength (SMD -0.48, 95% CI -0.73 to -0.24) and negative effect on the overall improvement effect (RR 0.66 (0.53 to 0.81)). For corticosteroid injection versus lidocaine injection, the evidence was conflicting. At long-term follow-up, there was no difference on overall improvement and grip strength, with conflicting evidence for pain. Manipulation and exercise versus no intervention showed beneficial effect at short-term follow-up (overall improvement RR 2.75, 95% CI 1.30 to 5.82), but no significant difference at intermediate or longterm follow-up. We found moderate evidence for shortterm and long-term effects of eccentric exercise and stretching versus no intervention. For exercise versus no intervention and eccentric or concentric exercise and stretching versus stretching alone, we found moderate evidence of no short-term effect. Conclusions: Corticosteroid injections have a shortterm beneficial effect on lateral epicondylitis, but a negative effect in the intermediate term. Evidence on the long-term effect is conflicting. Manipulation and exercise and exercise and stretching have a short-term effect, with the latter also having a long-term effect. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the antibiotic prescription pattern and factors that influence the physicians' choice of antibiotic. Design: Observational study. Setting: Primary healthcare in Norway, December 2004 through November 2005. Participants: 426 general practitioners, GPs, in Norway, giving 24 888 respiratory tract infection episodes with 19 938 children aged 0-6 years. Outcome measures: Assess antibiotic prescription details and patient and GP characteristics associated with broad-spectrum and narrow-spectrum antibiotic use. Results: Of the 24 888 episodes in the study, 26.2% (95% CI 25.7% to 26.8%) included an antibiotic prescription. Penicillin V accounted for 42% and macrolide antibiotics for 30%. The prescription rate varied among the physicians, with a mean of 25.5% (95% CI 24.2% to 26.7%). Acute tonsillitis gave the highest odds for a prescription, OR 33.6 (95% CI 25.7% to 43.9%), compared to 'acute respiratory tract infections and symptoms' as a reference group. GPs with a prescription rate of 33.3% or higher had the larger probability for broad-spectrum antibiotic prescriptions, OR 3.33 (95% CI 2.01% to 5.54%). Antibiotic prescriptions increased with increasing patient age. Conclusions: We found a low antibiotic prescription rate for childhood respiratory tract infections. However, our figures indicate an overuse of macrolide antibiotics and penicillins with extended spectrum, more so than in the corresponding study including the adult population. Palatability of antibiotic suspensions and other administrative challenges affect medication compliance in children. To help combat antibiotic resistance, guidelines need to be followed, in particular for our youngest patients. Trial registration number (clinicaltrials.org): NCT00272155. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effect of opioid maintenance treatment (OMT) on somatic morbidity in a cohort of OMT patients. Design: Retrospective cohort study. Setting: OMT programme in two Norwegian counties. Participants: 200 OMT patients, participation rate 71.2%. Main outcome measures: Incidence rates (IR) before, during and after OMT for acute/subacute hospital-treated somatic disease incidents (drug-related, non-drug-related, injuries) and rates for inpatient days and outpatient treatment contacts. Results: IR for drug-related hospital treatment episodes were 76% lower during compared to before OMT (before versus during incidence rate ratio (IRR) 4.2 (95% CI 2.9 to 6.2), p<0.001) and 11 times higher after compared to during OMT (after versus during IRR 11.1 (6.6 to 18.5), p<0.001). For non-drug-related treatment episodes, IR were 35% higher during than before OMT (before versus during IRR 0.7 (0.6 to 1.0), p=0.02) and 32% higher after compared to during OMT (IRR 1.4 (0.9 to 2.2), p=0.15), while injuries showed little change according to OMT status. Although patients with on-going drug-taking during OMT showed less reduction in drug-related hospital-treated incidents during treatment than patients not using illicit drugs, the quartile with most drug-taking showed a significant reduction (before versus during IRR 3.6 (2.4 to 5.3)). Patients who had experienced cessation of OMT showed a significant reduction in drug-related treatment episodes during OMT (before versus during IRR 1.7 (1.0 to 2.9)), although less than patients without OMT interruptions (before versus during IRR 6.1 (3.6 to 10.6)), and a significant increase after OMT cessation compared with during OMT (IRR 5.4 (3.0 to 9.7)). Conclusion: Acute/subacute drug-related somatic morbidity is reduced during compared to before OMT. This was also found for patients with on-going drug-taking during OMT. However, acute drug-related health problems show an increase after OMT cessation, and this is a matter of concern. Further studies on somatic morbidity after OMT cessation should be carried out. [ABSTRACT FROM AUTHOR]

Presents responses to the medical-related articles published in a 1999 issue of the `British Medical Journal.' Clinical evidence on acute otitis media; Population-based study of social and productive activities as predictors of survival among elderly people in the United States.

The article examines the feasibility of delayed prescribing of antibiotics in the treatment of women with mild or moderate symptoms of uncomplicated urinary tract infection (UTI). Topics covered include studies comparing antibiotics with placebo in women with uncomplicated UTI reporting delayed cure in the placebo group and how access to point-of-care testing such as urine phase contrast microscopy would help identify women who need antibiotics.

The author reflects on the study "Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial" by M. Moore and others, in the "British Medical Journal" in 2014. Topics discussed include effect of delay in prescribing for respiratory tract infections (RTIs) in lower antibiotic use, relationship between antibiotic prescribing and development of resistance and prescription of antibiotics by general practitioners.

The author comments on the link between frequent outpatient prescribing of antibiotics and high levels of resistant Streptococus pneumoniae. He notes studies done on the prognosis of respiratory tract infections which provide information for primary care doctors in providing treatment choices. The importance of assessing the severity of infections prior to prescribing antibiotics is discussed. He also cites the role of providing counseling to patients to reduce unnecessary use of antibiotics.

A letter to the editor is presented in response to the article about the effectiveness of topical steroids against amoxicillin and placebo for acute rhinosinusitis.

The article presents information on a study on the effectiveness of mometasone furoate nasal spray, amoxicillin, and placebo, for treating acute rhinosinusitis. Patients 12 years of age with signs and symptoms of acute rhinosinusitis were examined. The methods of the study, intervention, and outcomes are presented.

The article presents information on a research to compare the effects of topical steroids against amoxicillin and placebo for acute rhinosinusitis in primary care. The research was conducted by Meltzer. The research was large with more than 900 patients. The clinical significance of the difference between twice daily mometasone and placebo was unclear.

The article provides an answer to a question on the effectiveness of valacyclovir in reducing the transmission of genital herpes in couples with type 2 herpes simplex virus infection.

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.