Evidence for Primary Care: the latest evidence from the Trip Database

NICE

How should acne vulgaris be managed in primary and specialist care?

Clinical bottom line: Acne should be treated according to severity, with 12-week courses of combination topical therapy for most people and oral antibiotics added for moderate–severe acne when appropriate. Avoid antibiotic monotherapy, review treatment at 12 weeks, and refer urgently for acne fulminans or specialist input for severe, scarring, refractory, or psychologically distressing acne.

Brief summary: This NICE guideline covers acne care from skin advice to specialist treatment. It recommends gentle non-comedogenic skin care, no specific acne diet, and first-line combinations such as adapalene–benzoyl peroxide, tretinoin–clindamycin, or benzoyl peroxide–clindamycin. For moderate–severe acne, topical treatment plus doxycycline or lymecycline is recommended. Oral isotretinoin is reserved for severe acne resistant to adequate standard therapy, with pregnancy prevention and mental health monitoring.

Tools for Practice

In infants under 2 years with eczema, how effective and safe are topical treatments?

Clinical bottom line: In mild–moderate infant eczema, pimecrolimus and low- to medium-potency topical corticosteroids appear similarly effective, with similar short- and long-term safety. Steroids are much cheaper.

Brief summary: Pimecrolimus was better than vehicle in one RCT. In a large 5-year trial, pimecrolimus and topical corticosteroids produced similar clearance rates and adverse-event withdrawals. Evidence for steroid harms in children is generally reassuring when used intermittently and appropriately.

Australian Consensus Statement

How should frailty be prevented and managed in community-dwelling older adults?

Clinical bottom line: Frailty should be managed proactively using annual screening from age 65, personalised lifestyle counselling, protein-rich nutrition, progressive exercise, social prescribing, medication review, and person-centred care planning—especially in severe frailty. Evidence is partly consensus-based, but strongly supports a multidisciplinary, individualised approach.

Brief summary: This Australian consensus statement recommends integrated community frailty care across six areas: health promotion/screening, nutrition, exercise, social prescribing, medicines optimisation, and severe frailty management. Key actions include identifying frailty early, treating malnutrition and deficiencies, combining aerobic/resistance/balance training, supporting meaningful social engagement, reviewing medicines to reduce harm, and aligning severe-frailty care with patient goals, carers, advance care planning, and end-of-life preferences.

American Academy of Sleep Medicine

Should adults with chronic insomnia receive CBT-I plus medication, rather than either treatment alone?

JAMA Intern Med.

Can a patient- and GP-facing deprescribing intervention reduce long-term proton pump inhibitor use in primary care?

Clinical bottom line: A simple deprescribing intervention sent to both patients and GPs roughly doubled the proportion of long-term PPI users achieving at least a 50% dose reduction, without worsening reflux symptoms.

Brief summary: In this large French cluster RCT, 34,409 long-term PPI users were allocated to usual care, GP-only deprescribing advice, or combined patient and GP deprescribing support. Dose reduction occurred in 14.9% with the combined intervention versus 7.0% with usual care and 7.7% with GP-only advice. Reflux symptom scores did not differ meaningfully between groups.

J Am Med Dir Assoc.

Do different antihypertensive drug classes affect incident dementia risk in older adults?

Clinical bottom line: Antihypertensive treatment may modestly improve cognitive scores in older adults with hypertension, but evidence that it reduces incident dementia is uncertain. Drug-class rankings are exploratory and should not drive prescribing.

Brief summary: This systematic review included 4 RCTs with 16,823 older adults followed for 2.0–3.9 years. Antihypertensive therapy slightly improved cognitive function but did not significantly reduce dementia incidence. Exploratory analysis suggested possible differences by drug class, but the evidence was sparse and highly uncertain. Current findings support good blood pressure control rather than choosing a specific antihypertensive solely for dementia prevention.

NIHR

Can a group-based educational intervention help adults with chronic non-cancer pain reduce or stop strong opioid use?

Clinical bottom line: I-WOTCH helped substantially more people stop opioids at 12 months, without worsening pain interference. It may be cost-effective, but results apply mainly to people willing to reduce opioids.

Brief summary: In this primary-care RCT, 608 adults using strong opioids for chronic non-cancer pain received usual care or usual care plus I-WOTCH: group education, individual support, and nurse-led tapering follow-up. At 12 months, 29% in the intervention group versus 7% in usual care reported no opioid use, with no significant difference in pain interference. Opioid use was self-reported, and applicability to very high-dose or complex secondary-care patients is uncertain.

theNNT

Does testosterone replacement improve sexual dysfunction in men without confirmed hypogonadism?

Clinical bottom line: In men with sexual dysfunction but no confirmed testosterone deficiency, testosterone replacement shows no clear short-term benefit over placebo, PDE5 inhibitors, or PDE5 inhibitors alone when used in combination. Long-term benefit is uncertain.

Brief summary: This review of 43 RCTs found little to no clinically important improvement in erectile function or sexual quality of life with testosterone therapy in men without known hypogonadism. Evidence for long-term outcomes and comparisons with PDE5 inhibitors was limited or very uncertain. Current guidance supports checking and confirming consistently low testosterone before considering testosterone therapy.

NIHR

Which interventions safely and effectively reduce opioid use in adults with chronic non-cancer pain?

American Gastroenterological Association

How should hemorrhoids be diagnosed and treated?

Phys Ther.

Is first-contact physical therapy better than usual primary care for musculoskeletal disorders?

Clinical bottom line: First-contact physical therapy appears to reduce imaging and prescription medication use compared with usual primary care, with little or no difference in disability or quality of life. Effects on pain and cost are uncertain.

Brief summary: This systematic review of 10 RCTs involving 2,081 patients found that first-contact physical therapy was associated with lower imaging rates and fewer prescriptions for musculoskeletal disorders. Clinical outcomes were broadly similar to usual primary care: disability and health-related quality of life showed little difference, while pain and cost estimates favoured first-contact physical therapy but were uncertain. Evidence quality ranged from very low to moderate.

JAMA Netw Open.

Can a pelvic floor workout during pregnancy prevent postpartum stress urinary incontinence in first-time mothers?

Clinical bottom line: A structured pelvic floor workout from 28 weeks’ gestation reduced stress urinary incontinence at 6 weeks postpartum and improved pelvic floor muscle strength.

Brief summary: In this multicentre RCT of 764 primiparous women, PEFLOW plus usual care was compared with usual care alone. At 6 weeks postpartum, SUI occurred in 8.7% of the exercise group versus 13.9% of controls. More women in the exercise group also achieved higher pelvic floor strength scores. This suggests antenatal pelvic floor training can modestly reduce early postpartum SUI.

American Gastroenterological Association

How should functional constipation in children be diagnosed and managed?

Clinical bottom line: Pediatric functional constipation should usually be diagnosed clinically, using history and examination, with tests reserved for alarm features or treatment failure. First-line care is education, diet/lifestyle advice, toilet routines, and laxatives—especially PEG—with escalation to specialist and advanced therapies only if refractory.

Brief summary: This AGA–NASPGHAN pathway provides a practical approach for primary care and pediatric gastroenterology. It recommends using Rome IV criteria as a guide, avoiding routine abdominal X-rays, treating fecal impaction before maintenance therapy, and using osmotic laxatives first line. Neurodivergent children may need tailored assessment and behavioural support. Persistent, complex, or refractory cases may need specialist referral, motility testing, transanal irrigation, ACE procedures, or structured transition to adult care.

NIHR

Do weekly catheter washouts reduce blockage or infection in adults with long-term catheters?

Clinical bottom line: Weekly saline or acidic catheter washouts may reduce catheter blockages, and saline may reduce symptomatic catheter-associated UTI, but the evidence is inconclusive because the trial was stopped early and recruited only 80 participants.

Brief summary: In this UK pragmatic RCT, adults with long-term catheters were randomised to standard care, weekly saline washouts, or weekly acidic washouts. Washout groups had fewer catheter blockages requiring intervention, but differences were not statistically significant. Saline washouts reduced antibiotic-treated symptomatic catheter-associated UTI, though this finding should be interpreted cautiously. Washouts appeared acceptable and feasible for self-management after training, with few adverse events.

Diabetes Obes Metab.

Are GLP-1 and dual GLP-1/GIP receptor agonists safe in preconception, pregnancy, and lactation?

Clinical bottom line: Inadvertent preconception or early-pregnancy exposure to GLP-1-based therapies has not shown a consistent signal of increased maternal, fetal, or neonatal harm, but evidence remains limited—especially for continued use during pregnancy and lactation.

Brief summary: This systematic review included 36 human studies of GLP-1 or dual GLP-1/GIP receptor agonist exposure before conception, during pregnancy, or during lactation. Observational data did not consistently show increased risks of major congenital malformations, fetal growth restriction, stillbirth, or neonatal mortality after early exposure. Maternal outcomes were mixed, and lactation evidence was sparse, though one study found no detectable semaglutide in breast milk. Continued use during pregnancy remains insufficiently studied.

Tools for Practice

Is as-needed budesonide–formoterol an effective reliever treatment for asthma?

Clinical bottom line: In adults, as-needed budesonide–formoterol reduces severe asthma exacerbations compared with SABA reliever alone and appears similar to maintenance inhaled corticosteroids for exacerbation prevention. Evidence in children is limited.

Brief summary: RCT evidence suggests budesonide–formoterol used as a reliever lowers exacerbation risk versus SABA, especially in mild asthma. Compared with regular maintenance ICS, exacerbation rates are similar, though symptom control may be slightly worse. Adverse events are similar or lower than SABA, but most trials were industry sponsored and paediatric evidence is sparse.

NIHR

Which bedside tests best diagnose peripheral arterial disease in people with diabetes?

Clinical bottom line: Common bedside tests for peripheral arterial disease in people with diabetes had poor sensitivity and should not be relied on to rule out disease. Podiatry Ankle Duplex showed higher sensitivity, but was assessed only in selected centres.

Brief summary: This UK multicentre diagnostic accuracy study compared bedside tests with CT or MR angiography in adults with diabetes. PAD was present in 39% of those imaged. Sensitivity was low for audible waveform, visual waveform, toe–brachial pressure index, ankle–brachial pressure index, and exercise ankle–brachial pressure index. Podiatry Ankle Duplex performed better, but evidence was more limited.