[Top 4 Research Studies of the month for Italian Primary Care Physicians: April 2024.]

This monthly article provides a collection of summaries of the most relevant studies identified as POEMs (patient-oriented evidence that matters) for Italian primary care physicians. 1) In children and adults with acute conjunctivitis, antibiotic drops increase the likelihood that a patient will experience clinical recovery. Damage appears to be minimal for all agents other than fusidic acid (therefore, fusidic acid should be avoided). Since most patients improve without antibiotics, the benefit is modest, and there is a risk of antibiotic resistance, we would avoid them for patients with milder symptoms, especially immunocompetent adults. 2) A high quality randomized controlled trial was recently conducted on more than 4000 adult patients with recurrent episodes of subclinical atrial fibrillation. Trialists found that there was approximately 1 fewer ischemic stroke and 1 more major bleed for every 250 persons treated with apixaban instead of aspirin, but in people treated with apixaban major bleeding was also significantly more likely. This seems like a decision that requires an informed patient and shared decision-making. 3) In an intriguing but somewhat limited network meta-analysis, probiotics were equally or more effective than treatment with any antidepressant except escitalopram. Given the low advantage of standard treatments over placebo, probiotic treatment might be offered to patients who are reluctant to use antidepressants. 4) A recent meta-analysis showed that amyloid-targeting monoclonal antibodies do not provide any clinical meaningful benefits for patients with Alzheimer disease. Instead, they are associated with concerning risks of harm, most notably cerebral hemorrhage identified on imaging studies. The balance of risk versus benefit demonstrated thus far doesn't justify the use of these costly (over US$ 20,000 annually) drugs.