Not everything that is sold in a pharmacy cure. Beyond the controversial homeopathy and other pseudoterapias that have not demonstrated effectiveness in scientific reviews moderately serious, which many patients take to the pharmacy to treat the most common ailments is not always better. Sometimes, not even is effective. The association Farmaciencia has done a review of the scientific literature to recommend to his colleagues the remedies most appropriate, and to warn them of those that are useless or, even, counterproductive.
Evidence for treatments for minor ailments, distributed a few days ago, it is a document for professionals, “is not a guide to self-medication,” warns Carlos Alonso, president of Farmaciencia, a group of pharmacists that was joined a few years ago precisely in order to fight for their establishments basasen in the evidence to sell and recommend medicines.
MORE INFORMATION
Four analgesics among the 10 best-selling drugs of 2018 stock-outs of drugs increased by 45% in the past year
The guide says black on white that some treatments for 19 of the most common ailments (cold, otitis, cough, headaches…) are little more than placebo. Some examples of treatments without sufficient efficacy that the endorsements, according to the guide: the retinol for sore throat, antihistamines for nasal congestion; corticosteroids, topical, or chamomile for conjunctivitis; the omega 3 supplements for dry eye; oral and topical antibiotics, gauze hot and wipes scrubs to the stye; vitamin supplements for macular degeneration (vision disorder); plants such as senna, cascara sagrada, the frángula or the aloe for constipation.
The most striking is probably that of antitussives, which very often are no more effective than a glass of water and, in many cases, they can be dangerous to babies [to See an analysis of the effectiveness for each disease in the charts below]. “The treatment of acute cough non-specific, lacks good treatment options, especially if it is accompanied by mucus. The majority of drugs used today do not possess sound scientific evidence in favour of their use; in fact, some have a strong scientific evidence against it. In pediatrics there are no safe and effective medicines for children under two years old. There is solid scientific evidence that supports that none of the mucolíticos can shorten the duration, prevent complications or reduce the intensity of acute cough productive (with phlegm],” reads the guide, to which he has had access to this newspaper.
Alberto García-Salido, specialist in pediatric intensive care and member of the European Society of infectious diseases Pediatric, explains that to go to the pharmacy for a remedy for the cough of a small child is put in a “commitment” to the apothecary. “It is a symptom that drives the parent, are looking for something that will fix the problem and sometimes it is dispensed. In general, it is recommended to drink a lot of water to thin the secretions in adults. As the children do not ask, you have to be you over. With that, and with patience, that is to say, solved the majority of episodes of cough,” he summarizes. If persists, recommend you go to the doctor to find the causes and the best treatment.
Examples of treatments without sufficient effectiveness: the retinol for sore throat, antihistamines for nasal congestion; corticosteroids, topical, or chamomile for conjunctivitis
why, Then, do we sell you drugs that do not serve for nothing? Not exactly. All drugs considered as such (this is not the case of homeopathy or supplements, at least until now) must have proven some efficacy. What the guide reviews is the degree to which they are sold usually for certain ailments are the most suitable, or if it is really worth to take a drug for symptoms that usually go alone, when the medicine supposedly effective has a level of evidence very weak. That is to say: there have been some studies that have shown certain advantages, but not many, nor very strong.
The Ministry of Health, through a spokeswoman, explains that they are not licensed medicines without assessing their evidence, and without that it deems to be in its risk-benefit ratio is positive. “If a risk profile [side effects of the medicine] is low or very low, the benefit to be acceptable also could be small”, he says. “Even so, it is a complex issue, and there is that to consider, for example, that the evidence of treatments from years ago is not as strong as the new ones. To change, there is less uncertainty about their safety profile [adverse effects] because they have been using for tens of years,” he says.
The guide is not limited to reviewing drugs, but also some of the supplements or add-ons popular to certain conditions. Appears several times the zinc, which many customers take to treat cold sores, pharyngitis, and macular degeneration, without being really effective in any of them (except for very specific cases of the last); while itself has proven to be effective processes diarrheal.
The document also warns about the natural remedies, which “are not synonymous with safe.” Medicinal plants such as senna, cascara sagrada, or the frángula, derived hidroxiantracénicos, are not only ineffective for constipation, but its use is associated with both genotoxic (capable of causing genetic damage) and carcirógenos, according to the Safety Agency, European Food (EFSA, for its acronym in English).
being Asked by the guide, the General Council of Colleges of Pharmaceutical does not enter your content, and defends the work of the collective he or she represents: “Ensure the safety of the patient and promotes the good use of medicines, as well as the effectiveness of medicines, helping citizens, through the monitoring of their treatments.” The Association for Health Self-care (ANEFP), which encompasses companies that market many of the products referred to in the guide are not entered to assess its content.
The purpose of Farmaciencia, explains its president, is precisely to help this work, so only use the medication “necessary, effective, and safe.” This task is done, ” says Alonso, “without any funding from the industry, the margin of the pressures exerted on doctors and pharmacists to recommend certain products”.
Not only limited to disqualify the remedies that serve for little or nothing, but that also classifies that have more effectiveness for each disease. For example, despite the fact that Acyclovir is probably the antiherpético of more extended use, Penciclovir, which has demonstrated a greater efficacy.
The evidence for 19 ailments mild
What follows is a summary of the document 81-page, to simplify it to show what the report sets out as the best drugs, the effective, the cases which are not clear and those who are directly ineffective or counterproductive. Not a substitute for advice from professionals or the doctors, it is simply a guidance on the scientific evidence available that they have created 13 pharmacists association.
ACNE
acne affects 85% of adolescents and its prevalence decreases with age. It is the result of multiple processes that give rise to a bacterial growth and local inflammation. There are different types that respond best to different treatments. Although habits such as smoking are associated with an increased risk of acne and consumption of dairy also seems to have a relationship, there are many myths without evidence to sustain them, such as the consumption of chocolate. There is also no strong evidence that it linked to lack of hygienic habits.
The best
For the treatment of acne comedoniano, the topical retinoids are the best option is valued.
Effective
oral antibiotics have been shown to be an effective option for the treatment of acne, although there is quality information that allows for the selection of one as the best. Oral contraceptives are effective for women. Isotretinoin is recommended for nodular acne moderate or severe that does not respond to other therapies, although they are not clear that is better than the combination of oral antibiotics with topical treatment; nor are they clear in their side effects at the psychological level.
is Not clear
The effectiveness of using cleaning products specific for acne is very limited and generally of poor quality. Therapies light (irradiation with laser, photodynamic therapy) do not have high quality studies to recommend for or against.
Non-effective
The use of cosmetics with a large amount of oil can worsen the injury. Excessive washing also tends to be counterproductive. The sunlight has not shown efficacy. We strongly discourage the topical antibiotics in isolation, since they can generate resistance. There is No evidence to recommend alternatives, such as medicinal plants.
HERPES LABIAL
it Is the clinical form that arises after infection with the herpes simplex virus. Remain latent in the body until it reactivates, causing wounds in the mouth and face, generally. There are numerous factors that produce its revival, among which include cold, stress, menstruation, fever, UVB radiation and food irritants to which the patient is allergic.
The best
despite the fact that acyclovir is probably the antiherpético of more extended use, penciclovir, which has demonstrated a greater efficacy.
Effective
they are Also effective topically, the above-mentioned acyclovir and docosanol, even though the latter is effective only in the early stages of recurrence, since it has not demonstrated utility after the appearance of the vesicles. The oral antivirals have to be prescribed by a doctor. The patches of hydrocolloid delimit the affected area, produce calming effect, and accelerate healing.
is Not clear
The zinc salts are widely used and inhibit the replication of the virus in vitro, but the results in humans are contradictory, so they are not the best option.
Non-effective
are Not advised lip balms are soothing, reparative or sunscreens that do not have indication for the treatment of herpes labialis.
ESTOMATOSIS-and-MOUTH disease
Are a type of lesions in the oral cavity in the form of ulcers whitish. They are very painful, especially during chewing, and tend to produce relapses.
The best
Although no pharmacological treatment is curative, there are several treatments, topical or oral, is effective. Of all these, the corticosteroids are the most effective treatment.
Effective
Although you refer to in a natural way, there are effective options to reduce pain and inflammation: antiseptics: chlorhexidine gel or mouthwash, triclosan in gel or mouthwash; anti-inflammatory: acetonide of triamcionlona in solution or orabase (prescription) clobetasol propionate in solution or orabase (prescription), hydrocortisone in tablets for sucking; antibiotics: doxycycline (prescription); anesthetics: lidocaine, benzocaine, tetracaine; healing: hyaluronic acid, mouthwash or spray.
PHARYNGITIS
The sore throat is acute a pathology infectious origin, viral or bacterial.
Effective
Nonsteroidal anti-inflammatory drugs (much acetaminophen as ibuprofen), corticosteroids, anti-inflammatory topical (such as flurbiprofen), or prepared bucofaríngeos with a combination of several active principles have shown their effectiveness to reduce the symptoms. Antibiotics are effective only in the cases that are bacterial, not viral, they are the majority.
is Not clear
propolis has known issues of solubility, absorption and bioavailability, although it could be considered a complementary treatment that is valid for relieving pain in acute pharyngitis, but never as the only treatment in the variety of bacterial.
Non-effective
It has been shown that zinc does not reduce the symptoms or duration of pharyngitis, so that its use in some bucofaríngeos it would not be justified. No evidence has been found that supplementation with retinol can reduce the number of infections; in fact, some studies showed an increase of the same. The hypervitaminosis A can cause side effects, so its use is not recommended unless it is to demonstrate low serum levels of this micronutrient.
ACUTE COUGH
The productive cough is a physiological mechanism of defense, so that, although uncomfortable, is essential for the tree to respiratory be able to remove the excess mucus and other debris that occur during respiratory infections. The dry cough or irritative is made without expectoration (a nonproductive cough). This can last up to a month after resolved respiratory infection. In addition, it can lead to vomiting or interfere with sleep, so that justifies the need of such a treatment.
The best
For the treatment of dry cough in over two yearsI the best options would be the cloperastina and the levodropropizina.
Non-effective
the treatment of cough, acute non-specific, lacks good treatment options, especially if it is accompanied by mucus. The majority of drugs used today do not possess sound scientific evidence in favour of their use; in fact, some have a strong scientific evidence against it. In pediatrics there are no safe and effective medicines for children under two years old. There is solid scientific evidence that supports that none of the drugs mucosecretolíticos can shorten the duration, prevent complications or reduce the intensity of the cough-acute productive.
NASAL CONGESTION
The nasal congestion is the swelling of the nasal mucosa produced by the dilatation of nasal blood vessels, which causes an increase of blood flow and the filling of sinusoids.
Effective
decongestants adrenergic receptors, both nasal and oral, have been shown to be effective against nasal congestion.
is Not clear
corticosteroids intranasal, despite being effective in the majority of patients, did not demonstrate a significant improvement of the symptoms in important subgroups, for which further studies are required. Both the saline as the herbal medicine need more studies to demonstrate its effectiveness.
Non-effective
antihistamines do not have any significant effect on nasal congestion.
ALLERGIC RHINITIS
it Is a symptomatic condition of the nose caused by an inflammation of the membranes after the exposure to a particular allergen. Can be classified according to its duration (intermittent and persistent) and their severity (mild, moderate, or severe).
The best
corticosteroids intranasal are the best therapeutic option in the treatment of adults and children from six years of age, and are particularly effective in the relief of nasal congestion.
Effective
oral antihistamines (cetirizine, loratadine or mizolastina) constitute the treatments more employees. Are effective at relieving some of the symptoms of seasonal allergic rhinitis, but it is considered that they are less effective than corticosteroids. Oral decongestants (phenylephrine, pseudoephedrine), alone or combined with oral antihistamines improve symptoms and their combination is more effective than both drugs separately. Nasal decongestants quickly decrease nasal obstruction, but not recommended for prolonged use due to a rebound effect that occurs if you are using more than three or four days.
is Not clear
despite the fact that several studies indicate that some medicinal plants might be useful to relieve symptoms, the poor quality of the research prevents to make any recommendation on its use. Irrigation with saline may be an effective option, safe and economical compared to the use of corticosteroids or antihistamines. However, the quality of the evidence for making the recommendation is low.
CONJUNCTIVITIS
it Is an inflammation of the conjunctiva without condition corneal. The conjunctiva is the mucous membrane that lines the inner surface of the eyelids; it is generally transparent and turns pink-red to be inflamed.
The best
In the case of bacterial conjunctivitis, topical antibiotics have been shown to decrease the time of recovery; of choice are erythromycin and trimethoprim-polymyxin B. it Is necessary the prescription. In children it is preferable to use ointments eye, due to the complexity of able to administer eye drops.
is Not clear
We need specific studies in humans that demonstrate benefits in front of the washing with physiological serum.
Non-effective
The topical corticoids should not be used routinely in bacterial conjunctivitis because it is associated with complications such as corneal damage or perforation. Despite the widespread use of eye drops to base of plants for the treatment of different types of conjunctivitis, there are no clinical trials adequate to support the use of products to basis of Euphrasia officinalis, water Hammamelis or chamomile.
BLEPHARITIS
blepharitis is a diffuse inflammation along the eyelids and at the base of the eyelashes, and chronic with exacerbations occasional. The symptoms that causes are burning and itching eyelid.
Effective
In blepharitis anterior topical antibiotics are effective for the relief of symptoms and to eliminate the bacteria from the edges eyelid. There are No significant differences between the studied. Topical steroids are effective in the relief of symptoms, but are not effective in removing bacteria. The hygiene of the eyelid with specific products such as lotions or wipes and use warm compresses seem to be effective for the symptomatic relief in anterior and posterior blepharitis. Given the bactericidal activity, antifungal and acaricide of Melaleuca alternifolia, the tea tree oil can be an effective treatment for certain types of blepharitis.
Non-effective
there is conclusive evidence that supplements of omega-3 can relieve symptoms of dry eye or blepharitis. Despite the fact that there is a common recommendation, even by health care professionals, apply bags of chamomile hot on the eyelid, we have not found evidence of its effectiveness. On the contrary, the chamomile by itself can cause conjunctivitis and allergic reactions in sensitive people.
STYE
it Is a swollen gland in the eye that is usually caused by a bacterial infection.
The best
most of The times it is a process autorresolutivo. If you exceed the two weeks duration there are to go to the doctor. If there is no cure only surgery is the only method that has shown to be clearly effective.
Non-effective
oral and topical antibiotics, gauze hot, wipes, scrubs the eyelids, have not shown evidence of effectiveness. Some antibiotics might even be counterproductive, as this can cause resistance. Under no circumstances try to drain the glands are infected, as this can cause further damage.
DRY EYE
it Is the alteration most frequent of the ocular surface system or tear. Although it is considered a medical condition less, complications can arise. The symptoms can vary from a simple irritation to severe pain.
Cash
artificial tears have been shown to be an effective treatment and safetyro, although there are no good studies to know which is the best. The serum autológico, made from the patient’s own blood is effective, but has not demonstrated additional benefits artificial tears.
is Not clear
it Is considered that the eyelid hygiene consistent and done correctly, with wipes or other specific products, can help to relieve the symptoms, but the burden of evidence is limited.
Non-effective
today, there is not enough evidence to be able to demonstrate the effectiveness of the supplements of omega-3 in the treatment of dry eye disease.
MACULAR DEGENERATION ASSOCIATED TO AGE
The macular degeneration associated to age is the most common cause of blindness in people older than 60 years. At the beginning of the pathology can be asymptomatic, but as it progresses, patients complain of difficulty in visual acuity, which may end in a total loss of central vision. There has been no study demonstrating the effectiveness of pharmacological treatments for the prevention of this ailment.
Non-effective
We have developed many research to prove the efficacy of the intake of carotenoids, vitamins and minerals compared to the aggravation of the disease. But, for the general population, has not been found effectively solid to none.
NAUSEA AND VOMITING
Is defined as a nausea to the feeling of vomiting, localized vaguely in the epigastrium or throat, and that may or may not culminate in vomiting. It is not a disease as such, but a symptom produced by different causes; the most common are: gastrointestinal infection viral or bacterial, pregnancy, food poisoning or alcoholic, motion sickness (motion sickness), drugs or various diseases.
The best
The treatment of choice first line is the oral rehydration with water, glucose and electrolytes to prevent dehydration and to maintain the balance hydroelectric.
Cash
Antagonists to serotonin, such as ondansetron, are indicated on chemotherapy and when the vomiting does not subside in case of an acute gastroenteritis. It is used in gastroenteritis, especially when there is a risk of dehydration or has not been tolerated
oral rehydration.
is Not clear
Many herbal remedies are used as antiemetics, especially during pregnancy. Despite its widespread use, there are very few clinical studies about it, except on the ginger extract. Its use as an antiemetic is promising, but the evidence of their effectiveness is weak and little consistent. Are necessary best studies to establish its place in the clinic
Non-effective
as a general rule, medications to control vomiting in the emergency department are not necessary, as they tend to last a short time. There is No conclusive evidence to support the superiority of any drug over another, or the superiority of any drug over placebo. Normally, the severity of the nausea tends to decrease from the clinical point of view, to the 30 minutes, regardless of if it is given an antiemetic drug or a saline placebo. This makes the choice of the drug occasionally, based on the state of the patient or the profile of adverse effects.
HEARTBURN
The acidity of your stomach (heartburn) is described as a burning sensation painful behind the sternum that arises from the stomach and may spread from the mouth to the stomach up to the throat.
The best
The esomeprazole has shown to be slightly superior to the rest of the inhibitors of the proton pump (lansoprazole, omeprazole, pantoprazole, and rabeprazole)
Effective
inhibitors of the proton pump are more effective than H2-receptor antagonists for relieving heartburn. Antacids have a rapid action to relieve the symptoms, but not the long term or contribute to the healing of the erosion of the mucosa.
ACUTE DIARRHEA
diarrhea is defined as the decreased consistency or increased frequency of bowel movements, at least more than three a day. In most cases, acute diarrhea is a process is self-limiting and requires no specific treatment. It can be infectious, by poisoning, by drugs, by food intolerances or allergies, and in function of the cause, will vary the best treatment. The patient should take from the first time oral re-hydration solutions with water, glucose and salts. This does not shorten the duration of diarrhea, but prevents dehydration and maintains electrolyte balance.
The best
The use of probiotics in diarrhea it is today the indication of the available best scientific evidence. It has been shown to decrease the duration of episodes in a day and the number of stools on the second day of treatment.
Effective
Inhibitor of intestinal secretion (racecadotrilo) has proven its effectiveness in the management of acute diarrhea in children and adults. Antibiotics: use of antibiotics is not indicated routinely in the treatment of acute diarrhea, is only justified in case of bacterial diarrhea. Oral supplementation with zinc reduces the duration and severity of diarrhea.
is Not clear
routinely, it is recommended to follow a bland diet; however, this measure is not supported by studies of clinical efficacy. Inhibitors of intestinal motility (such as loperamide) has a low level of evidence, in some studies just as effective than placebo, in the other something more.
Non-effective
there are No studies that demonstrate the utility of the adsorbents, intestinal, such as activated carbon or methylcellulose.
CONSTIPATION
it Is considered constipated when you produce three bowel movements or less per week, with stools hard, dry, with straining or sensation of incomplete evacuation.
The best
The majority of clinical practice guidelines indicate that an increased intake of dietary fiber or fiber commercial should be the first therapeutic measure in patients with chronic constipation functional without symptoms of irritable bowel syndrome.
Effective
enemas can be effective, but use them with caution and not abuse them in order to avoid fluid overload, irritation and loss of muscle tone in the anal sphincter. Laxatives, both trainers of mass as osmotic have proven efficacy. The polyethylene glycol is the most efficient among these last. Among the stimulants, bisacodyl and sodium picosulfate give better results than the placebo in increasing the frecuencito bowel movements, a decrease in the consistency of the stools and improve the symptoms of constipation, although they should be tested before other alternatives.
is Not clear
Although probiotics have a positive effect by decreasing the colonic transit time, frequency of defecation and consistency, there are still few studies to determine its clinical utility with certainty. Lubricants, emollients, such as paraffin oil, glycerine provide a laxative effect which is due to produce an emulsion of faeces with lipid and water. There are No clinical trials with them, even though they are used in clinical practice with caution.
Non-effective
Derived hidroxiantracénicos natural: senna, cascara sagrada, frángula or aloe. Despite its common use and its popularity, the Safety Agency European Food (EFSA, for its acronym in English) has issued a statement in relation to its use with both genotoxic and carcinogenic.
VENOUS INSUFFICIENCY
VARICOSE veins
venous insufficiency is a disease that is characterized because the venous return is hampered. It is estimated that 25% of women and 15% of adult men suffer from varicose veins, one of its manifestations.
Effective
it Is recommended that compression stockings that cover the entire affected area provided that there is no contraindication. Nonsteroidal topical steroids reduce the local symptoms of pain and inflammation associated with superficial thrombophlebitis in the legs, which is related to the occurrence of varicose veins. It is particularly relevant the use of capsules of horse chestnut. The use of oral anticoagulants or injected, under medical criteria, may be justified when the venous insufficiency of the patient requires it.
is Not clear
The effectiveness of derivatives venotónicos or flebotónicos and heparinoids topics is not clearly demonstrated.
HEMORRHOIDS
hemorrhoids are one of the pathologies anorectal benign more common and manifest with symptoms such as bleeding, pain, itching, and swelling.
Effective
The venotónicos or flebotónicos have shown a significant benefit in the relief of the symptoms of hemorrhoids, especially those that present with bleeding. There is No scientific data on the use of nonsteroidal anti-inflammatory drugs, corticosteroids, and other analgesics, but it is recommended when the haemorrhoids are associated with pain. At short times, the topical treatments improve symptoms, but their long-term benefit has not been demonstrated.
INSOMNIA
insomnia is a sleep disorder that causes difficulty in falling or maintaining sleep, or the feeling of not having had a good night’s sleep. It could also be defined as the dissatisfaction with the quantity or quality of sleep.
What more effective
The first option would be a non-pharmacological treatment good sleep hygiene and, in your case, psychotherapy.
Effective
The pharmacological treatment, if necessary, should be added to the therapies earlier. Hypnotics (benzodiazepines or not) are the drugs of choice. Antihistamines H1, such as diphenhydramine and doxylamine, have been approved in Spain as hypnotics that do not require a prescription, may have a role in the short-term treatment of insomnia in young adults, although it develops tolerance quickly. Melatonin is also associated with a hypnotic effect and increased propensity to sleep. The clinical relevance of these effects is very low, although it is considered a safe drug.
is Not clear
The review of the studies shows no clinical evidence with sufficient relevance in the valerian, so that it would not be useful in the treatment of primary insomnia. Decreases the latency time of the dream, but not significantly in the occasional insomnia, being in combinations with hops when you get somewhat better results, although not significant clinically.
HEADACHES
headache is a symptom that refers to any type of localized pain in the head. There are more than 150 types.
Effective
For the treatment of both tension-type headache and migraine may be used nonsteroidal anti-inflammatory drugs, such as ibuprofen, naproxen, acetaminophen, or aspirin. In the treatment of migraine can be combined, in function of the response, with triptans (almotriptan, sumatriptan, eletriptan, frovatriptan, naratriptan, rizatrptán and zolimitriptán).
is Not clear
Oxygen: breathing pure oxygen through a mask or inside of a hyperbaric chamber, despite the use of relatively extended, has not managed to clearly establish their effectiveness. Botulinum toxin injections are used for the treatment of chronic migraine. It has seen some improvement in terms of the reduction of the number of episodes per year, but has not been established superiority over other existing treatments. In the case of migraine headaches occasional, the evidence available is scarce.
