Tamsulosin for prevention of postoperative urinary retention: A systematic review and meta-analysis.

PURPOSE: To determine if administration of tamsulosin before and/or after surgery is safe and effective in preventing postoperative urinary retention (POUR). METHODS: A systematic review and meta-analysis comparing tamsulosin to control in patients undergoing surgery was conducted. The primary outcome was the incidence of POUR. Secondary outcomes included maximum urinary flow rate, surgery duration, International Prostate Symptom Score (IPSS), quality of life (QOL) score, and incidence of urinary tract infection (UTI). RESULTS: Twenty-three randomized controlled trials (N = 3,555) met inclusion criteria. All were qualitatively analyzed, but one was excluded from quantitative analysis due to lack of statistical data. The risk of POUR was significantly lower with tamsulosin compared with control (relative risk, 0.50; 95% CI, 0.38-0.67; P < 0.001). A significant increase in maximum urinary flow rate with use of tamsulosin versus control was also observed across 4 studies (difference in means, 2.76 mL/sec; 95% CI, 1.21-4.30; P < 0.001). No significant differences between tamsulosin and control were observed amongst the studies that reported mean duration of surgery (P = 0.932), IPSS (P = 0.133), QOL score (P = 0.166), and UTI incidence (P = 0.624). CONCLUSION: Administration of tamsulosin before and/or after surgery significantly reduced the risk of POUR and improved maximum urinary flow rate compared to control; however, it had no significant impact on mean duration of surgery, IPSS, QOL score, or UTI incidence. Nonetheless, it may be reasonable for providers to consider administering tamsulosin before and/or after surgery to prevent POUR.

Morphine and Methadone for Neonatal Abstinence Syndrome: A Systematic Review.

PURPOSE: To compare the effects of morphine and methadone on length of hospital stay (LOS) or treatment (LOT) and adverse effects in infants with neonatal abstinence syndrome (NAS). DESIGN: Systematic review. SAMPLE: PubMed, Google Scholar, Cochrane library, CINAHL, IPA, American Academy of Pediatrics, and clinicaltrials.gov were systematically searched to identify randomized controlled trials (RCTs) and observational studies. comparing morphine and methadone for NAS. OUTCOMES: LOS, LOT, adverse effects. RESULTS: One RCT, two cohort studies, and two chart reviews met inclusion criteria. Each had a low risk of bias. LOS ranged from 12.08 to 36 days with morphine and 21 to 44.23 days with methadone. LOT ranged from 7.46 to 22.9 days (morphine) and 13.9 to 38.08 days (methadone). Adverse effects were not reported. Clinical evidence comparing morphine to methadone for NAS treatment is limited and conflicting. A recommendation for one over the other cannot be made based on these outcomes.

Probiotics for the Treatment of Infantile Colic: A Systematic Review.

OBJECTIVE: To evaluate whether clinical data support the safety and efficacy of probiotics for the management of infantile colic. BACKGROUND: Probiotics have been suggested as a potential strategy for infantile colic, and the specific species that have been studied in healthy infants are considered to be safe. METHODOLOGY: A systematic review was conducted to identify randomized controlled trials (RCTs) evaluating the use of probiotic supplementation in infants with colic. RCTs with a primary end point assessing crying or fussing time were selected. A meta-analysis comparing "responders" to "nonresponders" in infants receiving probiotic versus control was conducted. The quality of trials selected was assessed. RESULTS: Five RCTs assessing 2 different strains of the probiotic Lactobacillus reuteri in mostly breastfed infants were identified. Analysis of response rates showed that infants receiving probiotics had a 2.3-fold greater chance of having a 50% or greater decrease in crying/fussing time compared to controls ( P = .01). Probiotic supplementation was not associated with any adverse events. CONCLUSION: Supplementation with the probiotic L. reuteri in breastfed infants appears to be safe and effective for the management of infantile colic. Further research is needed to determine the role of probiotics in infants who are formula-fed.

Dietary supplement interactions with antiretrovirals: a systematic review.

Many patients who take antiretroviral drugs also take alternative therapies including dietary supplements. Some drug-supplement combinations may result in clinically meaningful interactions. We aimed to investigate the evidence for dietary supplement interactions with antiretrovirals. A systematic review was conducted using multiple resources including PubMed, Natural Medicine Comprehensive Database, The Review of Natural Products, and Google Scholar. All human studies or case reports evaluating an interaction between a dietary supplement and an antiretroviral were selected for inclusion. Twenty-eight pharmacokinetic studies and case-series/case reports were selected for inclusion. Calcium carbonate, ferrous fumarate, some forms of ginkgo, some forms of garlic, some forms of milk thistle, St. John's wort, vitamin C, zinc sulfate, and multivitamins were all found to significantly decrease the levels of selected antiretrovirals and should be avoided in patients taking these antiretrovirals. Cat's claw and evening primrose oil were found to significantly increase the levels of antiretrovirals and patients should be monitored for adverse effects while taking these dietary supplements with antiretrovirals. This systematic review shows the importance of screening all human immunodeficiency virus patients for dietary supplement use to prevent treatment failure or adverse effects related to an interaction.

Characterization of Complementary and Alternative Medicine-Related Consultations in an Academic Drug Information Service.

PURPOSE: To characterize requests received through an academic drug information consultation service related to complementary and alternative medicines. METHODS: A retrospective review and descriptive analysis of drug information consultations was conducted. RESULTS: A total of 195 consultations related to complementary and alternative medicine were evaluated. All consultation requests involved questions about dietary supplements. The most common request types were related to safety and tolerability (39%), effectiveness (38%), and therapeutic use (34%). Sixty-eight percent of the requests were from pharmacists. The most frequent consultation requests from pharmacists were questions related to drug interactions (37%), therapeutic use (37%), or stability/compatibility/storage (34%). Nearly 60% of complementary and alternative medicine-related consultation requests were able to be completely addressed using available resources. Among review sources, Natural Medicines Comprehensive Database, Clinical Pharmacology, Micromedex, and Pharmacist's Letter were the most common resources used to address consultations. CONCLUSION: Utilization of a drug information service may be a viable option for health care professionals to help answer a complementary and alternative medicine-related question. Additionally, pharmacists and other health care professionals may consider acquiring resources identified to consistently answering these questions.

Regulatory alerts for dietary supplements in Canada and the United States, 2005-13.

PURPOSE: Dietary supplement regulatory alerts published by the Food and Drug Administration (FDA) and Health Canada were evaluated and characterized. METHODS: FDA MedWatch and Health Canada websites were reviewed to identify regulatory alerts regarding dietary supplements from January 1, 2005, through December 31, 2013. Alerts were analyzed to identify product characteristics that may be predictive of product quality issues and potential patient harm. RESULTS: A total of 1560 dietary supplement-related regulatory alerts were identified. Of those, 1287 (83%) were identified through Health Canada, and 273 (18%) were identified through FDA MedWatch. The country of origin of dietary supplements associated with regulatory alerts was not provided in most regulatory alerts; however, when their origin was provided, the United States was the most common. Dietary supplements intended for sexual enhancement were the subject of 33% of all regulatory alerts identified. Products purchased online were the most likely to be associated with a regulatory alert. Dietary supplements intended for sexual enhancement, weight loss, and bodybuilding or athletic performance appeared to pose the greatest risk for patient harm due to product contamination with a pharmaceutical such as a phosphodiesterase-5 inhibitor or sibutramine. CONCLUSION: Analysis of Canadian and U.S. regulatory alerts concerning dietary supplements revealed that more than 80% of the composite alerts were issued by Health Canada. The most common intended uses of supplements for which alerts were issued were sexual enhancement, weight loss, and bodybuilding or athletic performance. The most common reason for alerts was the presence of a pharmaceutical contaminant.

Comparison of Vitamin D Label Dosing Recommendations to North American National Guidelines.

Supplementation with vitamin D has become increasingly popular over the past decade, and numerous organizations have developed recommendations for the appropriate intake of vitamin D. Vitamin D supplements come in a variety of formulations and strengths and vary in their directions for use. This study was designed to compare vitamin D label dosing information with the recommendations in North American guidelines. A systematic search was conducted to identify 62 single-ingredient vitamin D products of which 1000 IU was the most common strength. Assessment of North American guidelines found recommended vitamin D dosing to range from 400 to 1000 IU daily, depending on age. Twenty-four (39%) of the products recommended a maximum dose within the range of 400 to 1000 IU daily. Thirty-eight (61%) and 19 (31%) products recommended maximum doses more than 1000 IU daily and 2000 IU daily, respectively. Labeled dosing recommendations of commercially available vitamin D supplements are largely inconsistent with North American recommendations.

Survey and Systematic Literature Review of Probiotics Stocked in Academic Medical Centers within the United States.

BACKGROUND: Probiotics have a wide variation in their effectiveness in preventing or treating conditions due to the varying beneficial effects of specific probiotic strains. In other words, there is no "generic equivalency" between different probiotic species. However, it is has been noted that many practitioners consider probiotics in generic terms and may not realize the impact of these differences between probiotics. OBJECTIVE: The aims of this study were to identify probiotics used in US academic medical centers and to determine whether those probiotics were supported by a reliable evidence base. METHODS: A phone survey of 126 inpatient pharmacies in US academic medical centers was conducted to determine which probiotics were stocked. A systematic search was conducted to identify relevant studies that were then critically evaluated to determine whether the identified probiotics are supported by a reliable evidence base. RESULTS: There was a 90.5% (114/126) response rate of academic medical centers that were contacted through the phone survey. Ten probiotic products were identified through the phone survey. The probiotic most often stocked in academic medical centers was Culturelle (27.2%) followed by Lactinex (25.4%). The systematic search identified evidence that evaluated Culturelle, Florastor, Lactinex, and VSL #3. Of those 4 probiotics, none were supported by a strong evidence base. However, the results suggested that both Culturelle and Florastor appear to be supported by more evidence compared to other probiotics. CONCLUSION: A majority of academic medical centers did not stock a probiotic that was supported by a reliable evidence base.