Nonprescription Treatment Research Articles

A Technology-Assisted Web Application for Consumer Access to a Nonprescription Statin Medication

BackgroundAlthough statins reduce adverse cardiovascular outcomes, less than one-half of eligible patients receive treatment. A nonprescription statin has the potential to improve access to statins. ObjectivesThis study sought to assess concordance between clinician and consumer assessment of eligibility for nonprescription statin treatment using a technology assisted self-selection Web application (Web App) and evaluate effect on low-density lipoprotein cholesterol (LDL-C) levels. MethodsThis study was a prospective actual use 6-month study to evaluate use of a Web App to qualify participants without a medical background for a moderate-intensity statin based on current guidelines. Participants entered demographic information, cholesterol values, blood pressure, and concomitant medications into the Web App, resulting in 3 possible outcomes: “do not use,” “ask a doctor,” and “OK to use.” ResultsThe study included 1,196 participants, with a median age of 63 years (Q1-Q3: 57-68 years); 39.6% were women, 79.3% were White, 11.7% were Black, and 4.1% had limited literacy. Mean LDL-C was 139.6 ± 28.3 mg/dL and the median calculated 10-year risk of atherosclerotic cardiovascular disease was 10.1% (Q1-Q3: 7.3%-14.0%). Initial Web App self-selection resulted in an outcome concordant with clinician assessment in 90.7% (95% CI: 88.9%-92.3%) of participants, and 98.1% (95% CI: 97.1%-98.8%) had a concordant final use outcome during treatment. Mean percent change in LDL-C was −35.5% (95% CI: −36.6% to −34.3%). Serious adverse events occurred in 27 (2.3%) participants, none related to the study drug. ConclusionsIn this actual use study, a technology-assisted Web App allowed >90% of consumers to correctly self-select for statin use and achieve clinically important LDL-C reductions. (Technology-Assisted Cholesterol Trial in Consumers [TACTiC]; NCT04964544)

Antimicrobial effect of chamomile-containing over-the-counter ear and eye drops.

Chamomile (Matricaria chamomilla) is a plant with known antimicrobial, anti-inflammatory, and analgesic properties. Homeopathic drops containing chamomile extract are often used for ear pain and chronic ear infections. We aimed to evaluate the antimicrobial effect of over-the-counter eardrops containing chamomile against organisms causing bacterial conjunctivitis and otitis externa. Liquid cultures of Streptococcus aureus and Pseudomonas aeruginosa were exposed to increasing concentrations of eardrops containing chamomile extract. Liquid cultures of S. aureus and Streptococcus pneumoniae were exposed to increasing concentrations of chamomile eye drops for 5, 10, 15, and 45 min. Colony forming units (CFUs) were assessed after 18 h. Viability assays for these organisms were performed using the resazurin microdilution assay. We observed a reduction in the number of P. aeruginosa CFUs when the bacteria were exposed to any of the three concentrations of the chamomile drops as early as 5 min, with maximal reduction upon exposure to the 30% concentration at 45 min. Reduction in S. aureus CFUs, on the other hand, was observed for all three concentrations as maximal in the 5 min of exposure. We observed a marked reduction in the number of S. aureus CFUs upon exposure to any of the three preparations of chamomile-containing eye drops, which was almost immediate at 10% concentration. Streptococcus pneumoniae reduction happened at 5 min and continued through the 45-min observation period for all three concentrations. Our findings suggest that over-the-counter ear drops containing chamomile extract could potentially be used as a non-prescription treatment for mild cases of otitis externa and bacterial conjunctivitis.

Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study.

The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Background: it is unknown why some scars remain painful long-term. We do not know if scar flexibility, inflammation or sensitivity to temperature or pressure relate to scar pain. We investigated if patients would enrol in scar research, if scar testing was tolerated and if clinical tests are useful for future scar studies. Study conduct: with ethical approval and consent, adult hand surgery patients were enrolled from one NHS hospital. Scar pain, inflammation and response to thermal, sharp and pressure tests were assessed at 1- and 4-months after surgery. Statistically, we analysed study participation, tolerance for clinical scar tests and if the scar tests related to scar pain. Findings: 21 participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No participants were injured due to scar testing. 70% of participants reported treating their scar independently. Neuropathic Pain Symptom Inventory (NPSI) allows participants to give a broad range of answers about their scar symptoms. Scores for clinical tests of scar flexibility and inflammation did not relate to participant-reported scar pain. Scars were more sensitive to tests of pin prick and cold than unaffected skin. What we learned: people with new hand scars participate in research and independently initiate scar treatment. Clinical testing of post-surgical hand scars is well tolerated. The NPSI is useful for exploring scar pain symptoms and may help us to learn about persistent scar pain. Pinprick and cold clinical tests may be useful objective pain tests for future scar research.

Nonprescription Treatment Options.

The pathogenesis of atopic dermatitis (AD) is complex and multifactorial. However, recent advancements in the genetics and pathophysiology of AD suggest that epidermal barrier dysfunction is paramount in the development and progression of the condition (Boguniewicz M, Leung DYM, Immunol Rev 242(1):233-246, 2011). In addition to standard therapy for AD, there are a plethora of nonprescription treatment modalities which may be employed. Over-the-counter treatments for atopic dermatitis can come in the form of topical corticosteroids, moisturizers/emollients, and oral antihistamines. Though these treatments are beneficial, prescription treatments may be quicker acting and more efficacious in patients with moderate to severe disease or during flares. OTC agents are best used for maintenance between flares and to prevent progression of mild disease. Alternative and complementary treatments lack strong efficacy evidence. However, wet wraps, bleach baths, and other treatments appear to be promising when used in conjunction with conventional treatments. With the financial burden of atopic dermatitis ranging from 364million to 3.8billion dollars each year in the United States, we suspect this topic will gain further research attention.

Insights into acne and the skin barrier: Optimizing treatment regimens with ceramide-containing skincare.

Acne is a common, complex, multifactorial inflammatory skin disease associated with epidermal barrier dysfunction. Beginning in childhood, acne affects many adolescents and adults. Acne is associated with lower self-esteem, anxiety, and depression and may cause scars and pigmentary sequelae. The review explores the relationships between acne and the skin barrier function and discusses nuances in the prevention, treatment, and maintenance of acne and its impact on the skin barrier. The advisors' previous publications addressed prescription and nonprescription pediatric acne treatment and skincare using cleansers, moisturizers, and a practical algorithm for treatment and maintenance, including skincare recommendations for pediatric acne patients and an algorithm for skin of color patients with acne. Before the meeting, literature was culled on the relationship between the skin barrier and acne and current best practices in acne, addressing prescription and nonprescription acne products and skincare as monotherapy, adjunctive, and maintenance treatment. After discussing 13 draft statements, the advisors applied the selected literature and drew from their clinical knowledge and experience, and agreed on five statements. The follicular epithelial barrier is directly involved with changes that occur during both comedogenesis and in stages of inflammation, especially with follicular rupture compromising the barrier's integrity. In acne-affected skin, sebaceous glands are larger, sebum excretion and filaggrin expression higher, and stratum corneum lipids are reduced. Educating patients and clinicians about inflammation's central role in acne and measures to reduce inflammation is essential. Skin irritation and xerosis from acne and treatments lead to poor treatment adherence. A skincare regimen should be included in the acne prevention, treatment, and maintenance care regimen and should be ongoing. Maintenance treatment with topical agents and skincare using gentle ceramide-containing cleansers and moisturizers is a recommended strategy after successfully controlling the disease. Epidermal barrier dysfunction contributes to acne exacerbation. Using the appropriate treatment and skincare helps to minimize irritation and inflammation, enhance treatment adherence, and improve patient outcomes.

The Many Faces of Pediatric Acne: A Practical Algorithm for Treatment, Maintenance Therapy, and Skincare Recommendations for Pediatric Acne Patients.

Pediatric acne is a common, complex, multifactorial inflammatory skin disease with various expressions in childhood that can be categorized by age, severity, and pubertal status. The Faces of Pediatric Acne Project (FoPAP) aims to improve patient outcomes. The FoPAP group developed an algorithm that follows a consensus paper and a clinical case series on pediatric acne by applying the selected literature and drawing from the clinical knowledge and experience of each group member. The algorithm addresses neonatal, infantile, mid-childhood, preadolescent, and adolescent acne and starts with education on acne, general measures for prevention, treatment, maintenance, and ongoing skin care. Evaluation of pediatric acne requires a directed medical history and physical examination. For mid-childhood acne patients, a workup is warranted, and endocrine-associated abnormalities necessitate referral to a pediatric dermatologist. The second section of the algorithm identifies the type of pediatric acne, followed by the third section on acne treatment using a prescription or nonprescription treatment and skincare options. After successfully controlling the disease, maintenance treatment with topical agents and skincare using gentle cleansers and moisturizers containing lipids such as ceramides is important. The pediatric acne algorithm offers a comprehensive approach to treating and maintaining pediatric acne. In addition, it may support healthcare providers to bring more attention to pediatric acne patients and improve outcomes. Schachner LA, Andriessen A, Latanya Benjamin L, et al. The many faces of pediatric acne: a practical algorithm for treatment, maintenance therapy, and skincare recommendations for pediatric acne patients. J Drugs Dermatol. 2023;22(6):539-545. doi:10.36849/JDD.7440&nbsp.

Community pharmacists' counseling regarding nicotine replacement therapy: A secret shopper study.

Nicotine replacement therapy (NRT) is a safe and effective non-prescription tobacco cessation treatment. While most community-based pharmacists periodically provide patient education regarding NRT, there is a gap in real-world evidence assessing the counseling provided. To assess community pharmacist counseling regarding NRT in a real-world setting. A cross-sectional secret shopper audit was conducted to collect data regarding NRT counseling from 120 community pharmacist encounters. Seventeen trained college of pharmacy students presented to community pharmacies using a standardized script asking about 1 of 3 common NRT products (patch, gum, and lozenge). Pharmacies were randomly selected from a list of all community pharmacies open to the public in Bexar County, Texas. A standardized assessment form was used to document product availability, counseling length, whether or not the 7 counseling points and 6 assessment questions that could help guide the pharmacist's counseling regarding NRT products were provided without prompting, and potential inaccuracy of any recommendations and counseling points. Descriptive statistics were calculated, and analysis of variance and Fisher's exact test were used to test for variation across site type and time of day. NRT was available for purchase without speaking to pharmacy staff in 99 of 120 (83%) pharmacies. The mean length of counseling was 136 (standard deviation= 91) seconds. The most common points discussed were recommended strength (72%), tapering schedule (58%), and assessment of the daily number of cigarettes smoked (56%). Forty-one (34%) pharmacists provided one or more potentially inaccurate counseling points, the most common being inaccurate tapering schedule (provided during 31 (26%) encounters). Only 15% of pharmacists referred auditors for additional help or recommended a follow-up. NRT was commonly accessible in community pharmacies outside of the pharmacy area. Opportunities for pharmacists to provide more complete and accurate information to better assist patients with safe and effective smoking cessation were identified.

Impact of the Neck and/or Shoulder Pain on Self-reported Headache Treatment Responses - Results From a Pharmacy-Based Patient Survey.

Neck and/or shoulder pain (NSP) frequently occurs together with headache. Therefore, we explored how patients with and without concomitant NSP differ in their baseline characteristics and in perceived treatment responses to an analgesic. An anonymous survey was performed among 895 patients with headache (735 self-reported tension-type headache [TTH]) who used an analgesic fixed-dose combination containing 400 mg ibuprofen and 100 mg caffeine as a non-prescription treatment. NSP was abundant among patients in our survey (60%) and was associated with >1 additional day of headache per month. Patients with NSP reported predominantly sedentary work more frequently than those without (40 vs. 29%); they also reported physical tension/poor posture as a perceived trigger factor more frequently (70 vs. 16%). The reported pain reduction was comparable in those with and without concomitant NSP regardless of whether assessed as mean pain rating (from about 6 to 1.5 on a 10-point rating scale), patients experiencing a ≥50% in pain reduction (89.6 vs. 88.8%) or becoming pain-free within 2 h (57 vs. 64%). However, recurrence of pain and use of another dose within the same day were more frequent with than without NSP. We conclude that concomitant NSP is frequent in patients with headache but does not substantially alter responses to a non-prescription medication.

Analysis and Evaluation of the Effects of Melatonin on Oral Keratinocytes: A Pilot Study

Objective: Twenty to 30 percent of children in cross-sectional studies have significant bedtime problems or night waking. Melatonin, a synthetic form of the hormone produced by the pineal gland as a biomarker of the circadian system, is a commonly used nonprescription pharmacologic treatment for sleep disorders in children. Many studies have demonstrated the effect of melatonin supplementation on sleep duration and sleep quality, which can improve overall systemic health and disease prevention. However, despite the growing number of studies demonstrating the effects of melatonin to improve disordered sleep, no available studies have evaluated the effects of melatonin on normal oral tissues. Based upon this lack of knowledge, the primary objective of this study is to evaluate any potential effects of melatonin on normal oral cells and tissues within the physiologically relevant (supplementation) range.
 Methods: Normal oral keratinocytes (OKF4) and human gingival fibroblasts (HGF-1) were obtained and cultured for this study. Melatonin was administered in 96-well growth assays at supplement-equivalent physiologic concentrations at the low, mid and high range (1, 5 and 10 ug/uL) to determine any effects on cellular growth and proliferation. Changes in cellular viability and expression of cell cycle and apoptosis-related pathways were also evaluated.
 Results: Curvilinear U-shaped dose responses were observed in OKF cells under melatonin administration, ranging from -11.4% (low), to a maximum of -13.6% (mid) and -5.0% (high) compared with non-treated controls, p=0.029. Dose-responses among HGF-1 cells ranged from +12.1% (low), +17.4% (mid), and +5.0% (high), p=0.021. No changes in cellular viability were observed between control and experimental cells. However, qPCR screening of total RNA revealed significant changes in cell cycle related pathways, including c-myc, GAPDH and P53 but no changes in any apoptosis-related pathways, including Bcl-2, Bax, caspase-3, caspase-8 and caspase-9.
 Conclusions: This study demonstrated that melatonin does affect growth but not viability among these cell lines, which was found to be dose-dependent. These results suggest that melatonin may have some limited effects on oral tissues that may influence wound healing and repair but may not affect normal physiologic function or other cellular pathways. In agreement with other pediatric literature supporting the safety of melatonin use, this pilot study does not reveal any deleterious effects that would caution against its use in children or adults.

The Many Faces of Pediatric Acne: How to Tailor Nonprescription Acne Treatment and Skincare Using Cleansers and Moisturizers.

Acne vulgaris (acne) is a common, complex, multifactorial disorder. Various expressions of acne in childhood can be categorized by age, severity, and pubertal status. To improve pediatric acne patients’ outcomes, various expressions of pediatric acne to educate and tailor nonprescription acne treatment and skincare using cleansers and moisturizers were defined and discussed. An expert panel of pediatric dermatologists and dermatologists reviewed and discussed nonprescription acne treatment and skincare literature. The results from the literature searches were used together with the panel’s expert opinion and experience to adopt various expressions of pediatric acne and prevention, treatment, and maintenance of the condition using nonprescription acne treatment and skincare. The panel agreed on sixteen acne patient profiles addressing various age categories of pediatric acne: neonatal acne: birth to ≤ 8 weeks; infantile acne: 8 weeks to ≤1 year; mid-childhood acne: 1 year to <7 years; preadolescent acne: ≥7 to 12 years; adolescent acne: ≥12 to 19 years or after menarche for girls. Nonprescription acne treatment and skincare products containing lipids such as ceramides play an important role in monotherapy, adjunctive, and maintenance treatment; however, their role in pediatric acne is not well defined and requires more studies. Pediatric acne deserves more attention from healthcare providers treating children regarding differential diagnosis, treatment, and maintenance using nonprescription acne treatment and skincare. J Drugs Dermatol. 2022;21(6):602-612. doi:10.36849/JDD.6872.

Scaly dermatoses: What’s that itch?

Chronic scaly dermatoses include dandruff, seborrheic dermatitis, and psoriasis. These disorders involve the epidermis, the uppermost layer of skin. The primary manifestation is scaling of the skin, with inflammation, erythema, and other changes in appearance of variable degree and severity. Individuals with scaly dermatoses can receive significant relief through focused OTC products and important educational tips from their pharmacist. Dandruff is the less-inflammatory form of scaly dermatoses. It manifests as a more subtle dermatitis with relatively fine scaling confined to the scalp and occasionally includes mild erythema or inflammation. The goals of self-treatment for dandruff are 1) to reduce the epidermal turnover rate of the scalp skin by reducing the number of Malassezia fungi on the scalp, 2) to minimize the cosmetic embarrassment of visible scaling, and 3) to minimize itch. Shampooing with a general-purpose nonmedicated shampoo daily or every other day often is sufficient to control mild to moderate dandruff. Nonprescription medicated antidandruff shampoos, including those with either a cytostatic agent or ketoconazole, are other options. Topical cytostatic agents include pyrithione zinc, selenium sulfide, and coal tar. These agents can decrease the rate of epidermal cell replication and are of limited effectiveness. Contact time is the key to any efficacy, so medicated shampoos should be massaged into the scalp and left on the hair for three to five minutes before rinsing. Use the medicated shampoo daily for one week, then two to three times weekly for two to three weeks, and thereafter once weekly or every other week to control the disorder. Nonprescription ketoconazole antifungal shampoo is active against most pathogenic fungi but is indicated specifically for Malassezia infections. This product is used twice a week for 4 weeks, with at least three days between each treatment. Once the disorder is controlled, apply once weekly to prevent relapse. Seborrheic dermatitis affects the scalp, face, and chest (usually the sternum) and typically features significant inflammation and erythema. The goals of self-treatment for seborrheic dermatitis are 1) to reduce inflammation and the epidermal turnover rate of the scalp skin by reducing the level of Malassezia fungi, 2) to minimize or eliminate visible erythema and scaling, and 3) to minimize itch. Because of the inflammatory nature of seborrheic dermatitis, treatment is similar to, but more aggressive than, that for dandruff. Topical corticosteroids are needed more frequently to treat the more significant inflammation in seborrheic dermatitis. Corticosteroid products may be used to manage seborrheic dermatitis whenever erythema persists after therapy with medicated shampoos. Hydrocortisone ointment should be applied no more than twice daily because of the reservoir effect of the stratum corneum, which slowly releases the corticosteroid over time, and potential greasiness. Treatment should continue until symptoms subside but for no more than 7 consecutive days since seborrheic dermatitis is rarely cured by nonprescription treatment. If the disorder worsens or symptoms persist longer than 7 days, a dermatologist or other knowledgeable health care provider should be consulted. Psoriasis is a highly inflammatory skin disorder characterized by raised plaques and adherent thick, silvery white scales. The goals of self-treatment for psoriasis are 1) to control or eliminate the signs and symptoms (i.e., inflammation, scaling, itching) and 2) to prevent or minimize the likelihood of flares. Mild cases of psoriasis, characterized by the presence of a few localized lesions no larger than a quarter, are amenable to self-treatment with topical agents. Patients with psoriasis should be encouraged to bathe with lubricating bath products two to three times per week using tepid water. Daily lubrication of the skin after a bath or shower is essential. Emollients moisturize, lubricate, and soothe dry and flaky skin as well as reduce fissure formation within plaques and help maintain flexibility of the surrounding skin. Emollients should be applied to the lesions within minutes of bathing. To be effective, these products need to be applied liberally with gentle rubbing, up to 4 times daily. Hydrocortisone ointment 1% is the nonprescription medication of choice for treatment of bright red lesions. In some patients, nonprescription treatment may be ineffective and more aggressive treatments may be needed. Psoriasis can be controlled but not cured, and remissions do occur. Patients should be educated on controlling the disorder to help prevent flare-ups and to better understand this disorder to help reduce associated emotional stress and frequency of psychogenic exacerbations.

The COVID-19 Pandemic and Antibiotic Use on the United States–Mexico Border

Background: The US–Mexico border represents a unique region of the country where antibiotics are more accessible and nonprescription treatment with antibiotics is deeply enculturated. Currently, both the United States and Mexico are experiencing widespread community transmission of SARS-CoV-2, which may have implications for antibiotic seeking and use. The objective of this study was to examine antibiotic seeking behavior as it relates to COVID-19 in the border region relative to the greater US and Mexico populations. Methods: An interdisciplinary team at The University of Arizona developed a survey to assess knowledge, attitudes, and beliefs about antibiotics along the US–Mexico border region (defined as 100 km from the border) and to compare findings from the border region to the broader US and Mexico populations. The team recruited survey participants through Amazon’s MTurk survey platform and through the distribution of recruitment flyers to community partners in Arizona and Mexico border regions from October 2020 to January 2021. Targeted recruitment was 750 through March 2021. We report here on findings from the first round of recruitment (n = 116). These participants were asked whether they had sought out antibiotics specifically as a treatment for COVID-19, as well as their general beliefs and behaviors on self-seeking antibiotics for illness. Results: As of January 24, 2021, we surveyed 116 participants: 82 (70.7%) from the United States and 34 (29.3%) from Mexico. Most participants (71.2%) were aged 25–44 years; 56.9% were male; and 50% reported Hispanic ethnicity. Of these, 13.8% lived within 100 km of the US–Mexico border. Overall, 21.6% of participants reported taking antibiotics to fight COVID-19–like illness. Of these participants, 28% obtained the antibiotics directly from a pharmacy, without a physician prescription, and 16% obtained them from an online vendor. Additionally, 33% of US respondents reported that they would be willing to travel to Mexico to obtain antibiotics if they were too difficult to obtain in the United States. Of these respondents, 55% said they would be willing to travel for >1 hour to obtain antibiotics. Conclusions: Preliminary data suggest that the COVID-19 pandemic will have widespread ramifications on antibiotic seeking behavior and could propagate antibiotic resistance. Targeted intervention strategies in the border region are necessary to mitigate the unique factors that contribute to antibiotic use in this area.Funding: NoDisclosures: None

A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain.

Purpose of the ReviewChronic low back pain (CLBP) is a major contributor to societal disease burden and years lived with disability. Nonspecific low back pain (LBP) is attributed to physical and psychosocial factors, including lifestyle factors, obesity, and depression. Mechanical low back pain occurs related to repeated trauma to or overuse of the spine, intervertebral disks, and surrounding tissues. This causes disc herniation, vertebral compression fractures, lumbar spondylosis, spondylolisthesis, and lumbosacral muscle strain.Recent FindingsA systematic review of relevant literature was conducted. CENTRAL, MEDLINE, EMBASE, PubMed, and two clinical trials registry databases up to 24 June 2015 were included in this review. Search terms included: low back pain, over the counter, non-steroidal anti-inflammatory (NSAID), CLBP, ibuprofen, naproxen, acetaminophen, disk herniation, lumbar spondylosis, vertebral compression fractures, spondylolisthesis, and lumbosacral muscle strain. Over-the-counter analgesics are the most frequently used first-line medication for LBP, and current guidelines indicate that over-the-counter medications should be the first prescribed treatment for non-specific LBP. Current literature suggests that NSAIDs and acetaminophen as well as antidepressants, muscle relaxants, and opioids are effective treatments for CLBP. Recent randomized controlled trials also evaluate the benefit of buprenorphine, tramadol, and strong opioids such as oxycodone.SummaryThis systematic review discusses current evidence pertaining to non-prescription treatment options for chronic low back pain.

Nonprescription acne vulgaris treatments: Their role in our treatment armamentarium-An international panel discussion.

BackgroundAcne vulgaris (acne), a common inflammatory skin disorder, has its peak incidence between 14 and 19 years of age, with girls frequently developing acne earlier than boys. Over recent years, persistent acne is becoming more prevalent in adult women.ObjectivesThis review and panel discussion addresses challenges in acne management, particularly in adult women. The role which nonprescription acne treatment can play is explored when used as monotherapy or as an adjunctive treatment for acne of all severity.MethodsThe best available evidence on nonprescription acne treatment was coupled with the opinion of an international expert panel of dermatologists to adopt statements and recommendations discussed in this review.ResultsAll severity of acne has a significant burden on patients. Addressing environmental factors that are important for the individual with acne may help to educate, prevent, effectively manage, and maintain acne, as per the panel. They agreed that the adult female acne population has unique needs because of their aging skin and social environment. Nonprescription acne treatment products may help to balance the efficacy and tolerability of prescription acne treatment. Currently, there are no specific guidelines for how to use nonprescription acne treatment products in these patients.ConclusionThe panel agreed that guidelines including nonprescription acne treatment either as monotherapy for mild acne or in combination with prescription treatments for more severe acne would address a significant unmet need.

Owner-reported flea treatment measures and skin disease in cats.

The aim of this study was to obtain information regarding the use of flea treatments and owner-reported flea infestation and skin disease. Owners of 1150 cats were recruited into a long-term longitudinal study ('Bristol Cats' study) and asked to complete questionnaires at set time points. Questionnaires 1 and 5 were used and included data collection for kittens aged 2-4 months (T1) and at 2.5 years of age (T2). Owners were asked which brand of flea treatment, if any, was used at each time point. At T2 owners were asked if they had noted signs of skin disease or fleas on their cat within the previous 12 months and if they had sought veterinary attention for the skin disease or fleas. IBM SPSS version 23 was used for statistical analyses. Skin disease at T2 was reported by owners of 55/1150 (4.8%; 95% confidence interval [CI] 3.7-6.2) cats. Many owners who reported skin disease (25/55 [45.5%]; 95% CI 32.3-58.7) had not sought veterinary attention. There were 81/1150 (7.0%; 95% CI 5.6-8.5) cats with reported head shaking and/or ear scratching within the past 12 months at T2. The majority of cats (204/286; 71.3%) received prescription flea treatments at both points. Use of non-prescription flea treatment at T2 was more likely to be associated with owner-reported skin disease/flea infestation than those who used prescription flea treatment ( P <0.001). There was a significant association between the reported presence of fleas and reported presence of skin disease at T2 ( P = 0.03). Despite the potential for reverse causality, the association between owner-reported skin disease and/or flea infestation in their cats and the use of non-prescription flea treatment was as expected. Use of flea treatments and, in particular, the type of ectoparasite control used (prescription or non-prescription) should be carefully assessed when managing cats with skin disease.

From Acute Disease to Red Flags: A Review of the Diverse Spectrum of Red Eye Encountered in the Primary Care Setting

The general practitioner is most often the first contact physician for the patient presenting with red eye. The majority of red eye is a symptom of benign disease, such as conjunctivitis, episcleritis and sub-conjunctival hemorrhage, which can resolve on its own or by non-prescription medication and treatment in the primary care setting. Red eye caused by scleritis, keratitis, foreign bodies, trauma, chemical exposure, cellulitis and acute angle-closure glaucoma can be sight-threatening and there are a myriad of differential diagnoses, including systemic diseases, that can be life-threatening and require referral to an ophthalmologist. We provide an updated general review of the benign causes of red eye and recommend guidelines to provide a comprehensive assessment, accurate diagnosis and successful management for first contact physicians and primary care providers with the aim to reduce misdiagnoses and strengthen the referral of patients with sight- and lifethreatening disorders to ophthalmologists. Given the limited training, equipment and tools primary care providers have in ophthalmology, it is important that these clinicians can correctly assess red eye to identify benign or non-serious conditions and recognize when a case merits urgent referral, always keeping in mind that any case of red eye may require intervention by an ophthalmologist. It is important that the first contact physician or primary care provider knows the characteristics of the red eye that require an urgent assessment by an ophthalmologist. Patients whose symptoms persist, worsen, or recur after initial treatment should also be urgently referred to an ophthalmologist.

Closing the Deal: A Cross-Cultural Comparison of Treatment Resistance

ABSTRACTThis study investigates patient resistance to doctors’ treatment recommendations in a cross-national comparison of primary care. Through this lens, we explore English and American patients’ enacted priorities, expectations, and assumptions about treating routine illnesses with prescription versus over-the-counter medications. We perform a detailed analysis of 304 (American) and 393 (English) naturally occurring treatment discussions and conclude that American and English patients tend to use treatment resistance in different prescribing contexts to pursue different ends. While American patients are most likely to resist recommendations for non-prescription treatment and display an expectation for prescription treatment in these interactions, English patients show a high level of resistance to recommendations for all types of treatment and display an expectation of cautious prescribing. These behavioral trends reflect broader structural forces unique to each national context and ultimately maintain distinct cultural norms of good-practice prescribing.

Non-Prescription Treatment Options.

The pathogenesis of atopic dermatitis (AD) is complex and multifactorial. However, recent advancements in the genetics and pathophysiology of AD suggest that epidermal barrier dysfunction is paramount in the development and progression of the condition (Boguniewicz and Leung, Immunol Rev 242(1):233-246, 2011). In addition to standard therapy for AD, there are a plethora of non-prescription treatment modalities which may be employed. Over-the-counter treatments for atopic dermatitis can come in the form of topical corticosteroids, moisturizers/emollients, and oral anti-histamines. Though these treatments are beneficial, prescription treatments may be quicker acting and more efficacious in patients with moderate to severe disease or during flares. OTC agents are best used for maintenance between flares and to prevent progression of mild disease. Alternative and complementary treatments lack strong efficacy evidence. However, wet wraps, bleach baths, and other treatments appear to be promising when used in conjunction with conventional treatments. With the financial burden of atopic dermatitis ranging from 364 million to 3.8 billion dollars each year in the United States, we suspect this topic will gain further research attention.

Non-prescription proton-pump inhibitors for self-treating frequent heartburn:the role of the Canadian pharmacist.

Heartburn and acid regurgitation are the cardinal symptoms of gastroesophageal reflux and occur commonly in the Canadian population. Multiple non-prescription treatment options are available for managing these symptoms, including antacids, alginates, histamine-H2 receptor antagonists (H2RAs), and proton-pump inhibitors (PPIs). As a result, pharmacists are ideally positioned to recommend appropriate treatment options based upon an individual’s needs and presenting symptoms, prior treatment response, comorbid medical conditions, and other relevant factors. Individuals who experience mild heartburn and/or have symptoms that occur predictably in response to known precipitating factors can manage their symptoms by avoiding known triggers and using on-demand antacids and/or alginates or lower-dose non-prescription H2RAs (e.g. ranitidine 150 mg). For those with moderate symptoms, lifestyle changes, in conjunction with higher-dose non-prescription H2RAs, may be effective. However, for individuals with moderate-to-severe symptoms that occur frequently (i.e. ≥2 days/week), the non-prescription (Schedule II) PPI omeprazole 20 mg should be considered. The pharmacist can provide important support by inquiring about the frequency and severity of symptoms, identifying an appropriate treatment option, and recognizing other potential causes of symptoms, as well as alarm features and atypical symptoms that would necessitate referral to a physician. After recommending an appropriate treatment, the pharmacist can provide instructions for its correct use. Additionally, the pharmacist should inquire about recurrences, respond to questions about adverse events, provide monitoring parameters, and counsel on when referral to a physician is warranted. Pharmacists are an essential resource for individuals experiencing heartburn; they play a crucial role in helping individuals make informed self-care decisions and educating them to ensure that therapy is used in an optimal, safe, and effective manner.

Non-prescription treatment of NSAID induced GORD by Australian pharmacies: a national simulated patient study

Patients regularly present to community pharmacies for advice about and treatment for reflux symptoms and NSAIDs are a common cause of these symptoms. There is no published literature detailing the approach that pharmacies take to these enquiries, the pharmacotherapy they recommend or whether they contribute to the safe and effective use of reflux medicines. To assess in an observational study design the clinical history gathering, recommendations for GORD management and counselling provided by community pharmacies in a simulated patient scenario involving suspected NSAID induced reflux symptoms. Setting Australian community pharmacies. Simulated patients visited 223 community pharmacies to request treatment for reflux symptoms. The interaction was audiotaped and assessed against guidelines for the treatment of reflux symptoms. Alignment of community pharmacies with international expert gastroenterologist guidance and national professional practice guidelines for the treatment of reflux symptoms by pharmacists including: consultation with a pharmacist; confirmation of reflux diagnosis based on symptoms; recommendation of short courses proton pump inhibitor (PPI) therapy; advice on the safe and effective use of reflux medicines and referral to a doctor for further assessment. Pharmacists consulted with the simulated patient in 77% of cases. Symptoms were enquired about in 95% of cases and a medicines history taken in 69% of cases. Recommendations for treatment included: PPIs (18%), histamine H2 antagonists (57%) and antacids (19%). Advice on product use was given in 83% of cases. Referral to a doctor to discuss reflux symptoms was made in 63% of cases. When assessing patients for the symptoms of GORD, Australian pharmacists and non-pharmacist support staff take a comprehensive history including symptomatology, duration of symptoms, concomitant medicines and medical conditions and any GORD treatments previously trialled. They provide comprehensive counselling on the use of antisecretory and antacid medicines. Counselling could involve more comprehensive information on lifestyle approaches for GORD management and side effects of antisecretory and antacid medicines. Further alignment with guidelines for the management of GORD would result in greater referral to a doctor for assessment of recurrent GORD and greater recommendation of PPIs for symptoms. However alignment with guidelines by all pharmacists is unrealistic if the guidelines are not universally available to them.