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• Parere degli esperti
• Pubblicazioni
• Esperienza clinica
• Adeguamento della
• terapia al singolo
• paziente

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Prima di far praticare un esame, bisogna
chiedersi quale sarà l'atteggiamento a) se il
risultato è positivo b) se il risultato è
negativo. Se nei due casi l'atteggiamento
previsto è identico, l'esame non va
richiesto Archibald Cochrane L'inflazione
medica. Efficacia ed efficienza in
medicina prima edizione 1972
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- acetaminophen, chlorpheniramine,
dextromethorphan, pseudoephedrine
- Pseudoephedrine, phenylpropanolamine,
dextromethorphan,
- phenylpropanolamine, brompheniramine
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Antibiotics for acute maxillary sinusitis
(Cochrane Review)
Williams Jr. JW, Aguilar C, Makela M, Cornell J,
Hollman DR, Chiquette E, Simel DL
Reviewers' conclusions For acute maxillary
sinusitis confirmed radigraphically or by
aspiration, current evidence is limited but
supports penicillin or amoxicillin for 7 to 14
days. Clinicians should weigh the moderate
benefits of antibiotic treatment against the
potential for adverse effects.
Decongestants and antihistamines for acute otitis
media in children (Cochrane Review)
Flynn CA, Griffin G, Tudiver F

Reviewers' conclusions Given lack of benefit and
increased risk of side effects, these data do not
support the use of decongestant, antihistamine,
or combined DC/AH treatment in children with AOM.
The small statistical benefit found in the
combination medication group is of small clinical
significance and study design may be biasing the
results.
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Nasal decongestants for the common cold (Cochrane
Review)
Taverner D, Bickford L, Draper M
Reviewers' conclusions A single dose of nasal
decongestant in the common cold is moderately
effective for the short term relief of congestion
in adults, while there is no evidence available
to show benefit after repeated use over several
days.These medications are not recommended for
use in young children with the common cold.
Oral or topical nasal steroids for hearing loss
associated with otitis media with effusion in
children (Cochrane Review)

Butler CC, van der Voort JH

Reviewers' conclusions There is evidence that
steroids combined with an antibiotic lead to a
quicker resolution of OME in the short term.
However, there is not evidence for long term
benefit from treating hearing loss associated
with OME with either oral or topical nasal
steroids. These treatments are therefore not
recommended at the present time. Future studies
should document hearing loss associated with OME
before the start of study treatment. Follow up
should be longer and ideally include symptom,
audiometry and developmental outcomes.
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Vaccines for preventing influenza in people with
asthma (Cochrane Review)
Cates CJ, Jefferson TO, Bara AI, Rowe BH
Reviewers' conclusions There is not enough
evidence to assess the benefits and risks of
influenza vaccination for people with asthma.
Pneumococcal vaccine for asthma (Cochrane Review)
Sheikh A, Alves B, Dhami S.
Reviewers' conclusions This review found very
limited evidence to support the routine use of
pneumococcal vaccine in people with asthma. A
randomised trial of vaccine efficacy in children
and adults with asthma is needed.
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Echinacea for preventing and treating the common
cold (Cochrane Review)
Melchart D, Linde K, Fischer P, Kaesmayr J
Reviewers' conclusions The majority of the
available studies report positive results.
However there is not enough evidence to recommend
a specific Echinacea product, or Echinacea
preparations for the treatment or prevention of
common colds.
Homoeopathic Oscillococcinum for preventing and
treating influenza and influenza-like syndromes
(Cochrane Review)


Vickers AJ, Smith C.
Reviewers' conclusions Oscillococcinum probably
reduces the duration of illness in patients
presenting with influenza symptoms. Though
promising, the data are not strong enough to make
a general recommendation to use Oscillococcinum
for first-line treatment of influenza and
influenza-like syndrome. Further research is
warranted but required sample sizes are large.
Current evidence does not support a preventative
effect of homeopathy in influenza and
influenza-like syndromes.
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Antibiotics for acute bronchitis (Cochrane
Review)
Smucny J, Fahey T, Becker L, Glazier R
Reviewers' conclusions Overall, antibiotics
appear to have a modest beneficial effect in
patients who are diagnosed with acute bronchitis.
The magnitude of this benefit, however, is
similar to that of the detriment from potential
adverse effects. Furthermore, patients with other
symptoms of the common cold who have been ill for
less than one week are not likely to have any
benefit from antibiotics.
Chest radiograph in acute respiratory infections
in children (Cochrane Review)


Swingler GH, Zwarenstein M
Reviewers' conclusions There is no evidence that
chest radiography improves outcome in ambulatory
children with acute lower respiratory infection.
The findings do not exclude a potential effect of
radiography, but the potential benefit needs to
be balanced against the hazards and expense of
chest radiography. The findings apply to
ambulatory children only.
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Beclomethasone for asthma in children effects on
linear growth (Cochrane Review)
Sharek PJ, Bergman DA, Ducharme
Reviewers' conclusions In children with
mild-moderate asthma, beclomethasone 200 mcg
twice daily caused a decrease in linear growth of
-1.54 cm per year. These studies lasted a maximum
of 54 weeks, so it remains unclear whether the
decrease in growth is sustained or whether it
reverses with 'catch up' after therapy is
discontinued. We are unable to comment on growth
effects of other inhaled steroids that have
potentially less systemic effects. If inhaled
steroids are required to control a child's
asthma, we recommend using the minimum dose that
effectively controls the child's asthma and
closely following growth


Inhaled beclomethasone versus placebo for chronic
asthma (Cochrane Review)
Adams NP, Bestall JB, Jones PW
Reviewers' conclusions This review has
quantified the efficacy of BDP in the treatment
of chronic asthma and strongly supports its use.
Current asthma guidelines recommend titration of
dose to individual patient response, but the
published data provide little support for dose
titration above 400 mcg/d in patients with mild
to moderate asthma. There are insufficient data
to draw any conclusions concerning dose-response
in patients with severe disease.
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Heated, humidified air for the common cold
(Cochrane Review)
Singh M.
Reviewers' conclusions Three trials demonstrated
beneficial effects on the symptoms of the common
cold. One study from Israel showed a decrease in
nasal resistance measured by peak nasal
expiratory and inspiratory flow rate. Studies
done in North America failed to show any
objective improvement in outcome measures with
the study intervention. A multi-centre double
blind randomised controlled trial testing this
therapy with uniform outcome measures is
recommended
House dust mite control measures for asthma
(Cochrane Review)


Gøtzsche PC, Johansen HK, Burr ML, Hammarquist C
Reviewers' conclusions Currently available
evidence from controlled trials of chemical and
physical approaches to reducing exposure to house
dust mite antigens in the homes of mite-sensitive
asthmatics does not provide a secure basis for
advice and policy. Further trials one of them
very large - are currently in progress. The
additional evidence from these studies will help
to clarify whether or not the substantial efforts
required to implement strategies intended to
reduce mites can be expected to yield beneficial
effects of a magnitude that people with mite
sensitive asthma consider worthwhile.
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Perizia Prudenza Diligenza
Deontologia Etica Bioetica
Scienza Coscienza
Leggi -Finanziaria -675/96 -626 -502 -ecc. ecc.
Economia sanitaria Farmacoeconomia DRG
(ROD) Budget EBM ECM