Medycyna Faktow (J EBM)

Eradication of Helicobacter pylori in 2025 – new recommendations, practical challenges, and effective treatment strategies

2025-08-08T18:01:45+02:00

Helicobacter pylori infection remains a significant clinical challenge, particularly due to the increasing bacterial resistance to antibiotics. This article discusses the latest recommendations for the diagnosis and treatment of H. pylori in 2025, based on both Polish and international guidelines. The indications for testing, diagnostic methods, and current therapeutic regimens are reviewed. The importance of appropriate treatment selection and factors influencing therapeutic success, such as adherence to medical recommendations and proper monitoring of treatment outcomes, is emphasized. A comprehensive approach to diagnosis and treatment, considering individual patient characteristics and epidemiological factors, may improve eradication success rates and reduce the long-term consequences of infection.

Large doses of vitamin D in light of current guidelines regarding and recommendations

2025-08-08T18:01:44+02:00

Vitamin D plays a key role in the body, influencing various physiological processes. Its main function is to regulate calcium and phosphate metabolism and to influence the health of the musculoskeletal system and to prevent bone diseases such as rickets in children and osteomalacia in adults. Recent studies have also shown that vitamin D can also exert pleiotropic effects, and its deficiency has been demonstrated in a great many diseases. Although there are still gaps in knowledge and controversy regarding the potential extraskeletal effects of vitamin D, it is widely accepted that the high incidence of vitamin D deficiency worldwide is worrying and requires preventive measures. In recent years, less frequent vitamin D dosing regimens (once a week, every 2 weeks and once a month) have also been available and promoted, which are a safe and willingly preferred alternative to daily therapy by some patients. This article summarizes the current recommendations and guidelines regarding vitamin D supplementation and treatment, especially in higher and less frequent doses.

From differential diagnosis, through therapeutic errors, to recommendations for effective treatment. What is worth to know about skin and nail mycosis?

2025-08-08T18:01:43+02:00

In superficial mycoses caused by dermatophytes and yeasts treatment is require. In many cases, local treatment is sufficient. In cases of extensive and disseminated lesions, oral therapy with antifungal drugs is used.

Why does health start with the gut? The importance of microbiota and the use of probiotics in the context of maintaining mental health and supportive treatment of mental disorders. Part I

2025-08-08T18:01:42+02:00

In recent decades, there has been growing interest in the influence of gut microbiota on human mental and physical health. Understanding the role of microbiota, including interactions between the digestive system and the central nervous system, is of particular importance in the context of lifestyle diseases, including the increasing prevalence of mental disorders. Research results indicate that the composition of gut microbiota may differ significantly between healthy individuals and those suffering from depressive or anxiety disorders. This fact provides the basis for research on the use of probiotics and psychobiotics as a potential support for standard pharmacotherapy. This article discusses the importance of microbiota, not only in terms of physical health, but also mental health, pointing to key mechanisms of the brain-gut axis and discussing the possibilities of using probiotics in the treatment of depression, schizophrenia and bipolar disorder.

Profiles of patients who may benefit from high-dose venlafaxine therapy

2025-08-08T18:01:41+02:00

Venlafaxine is a reuptake inhibitor of serotonin, noradrenaline and, to a lesser extent, dopamine. The dose-dependence of the drug’s mechanism of action is clinically important. In lower doses, it inhibits serotonin reuptake, increasing the daily dose of the drug allows the activation of the noradrenergic mechanism, and in the highest therapeutic doses, additionally the dopaminergic mechanism. Therefore, the use of various doses allows for improvement in a wide spectrum of clinical symptoms of depression, and venlafaxine has a number of registered indications. The drug – especially in higher doses – is particularly useful in the treatment of depression and apathy, anergy, fatigue, drug-resistant depression or depression with coexisting chronic pain.

Leflunomide as an option for RA treatment in questions and answers

2025-08-08T18:01:40+02:00

Leflunomide is a drug recommended for the treatment of rheumatoid arthritis. The article discusses its place in therapy, drug dosage, conditions of reimbursement of the drug for the patient and precautions in case of procreation plans or pregnancy.

Combination of tramadol with paracetamol in pain pharmacotherapy. Why is the soluble form of the drug so important in practice?

2025-08-08T18:01:39+02:00

In clinical practice, pain is most often caused by complex pathophysiological mechanisms. It is obvious that no single analgesic can fully modify multiple mechanisms of pain development. Analgesics with different mechanisms of action are effective because they activate multiple pain-inhibiting pathways and provide more effective and optimal pain control. Moreover, combinations of different analgesics, in addition to potentiating therapeutic effects, additionally reduce the risk of adverse effects in a patient with pain. One of the elements of effective pain pharmacotherapy is the selection of soluble forms of the drug in different patient populations.

What is indigestion and how we can we treat it?

2025-08-08T18:01:38+02:00

One of the most common reasons for visiting a doctor’s office, not only specialist ones, is the feeling of indigestion, postprandial fullness, flatulence and discomfort in the epigastrium reported by patients. These symptoms are very non-specific, they may concern dyspepsia, functional disorders of the gallbladder and bile ducts, but also functional disorders of the irritable bowel type. Diagnosis is difficult due to frequent overlap syndromes, and treatment includes pharmacological treatment, including antispasmodic and analgesic drugs, as well as surgical procedures, e.g. sphincterotomy of the sphincter of Oddi or cholecystectomy. It is important to remember to individualize the procedure, especially when qualifying for surgical treatment.

Naltrexone in the treatment of alcohol addiction

2025-08-08T18:01:37+02:00

According to the World Health Organization, alcohol is the third most important risk factor for the health of the population, and more than 200 types of illness and injury are associated with its consumption. In Poland, alcohol abuse is estimated at 3–4 million people, including about 900,000 with symptoms of dependence. The recommendations of the Polish Psychiatric Association list a number of drugs supporting the treatment of alcohol addiction – one of them is naltrexone. Naltrexone is an effective and at the same time safe drug supporting the treatment of alcohol dependence. Numerous studies cited in this study indicate the effectiveness of naltrexone in blocking the effect of positive reinforcement of alcohol consumption, as well as reducing its hunger and promoting abstinence.

Eight faces of ezetimibe, that is a therapeutic signpost for practicing physician A.D. 2025

2025-08-08T18:01:36+02:00

Hypercholesterolemia is the most common cardiovascular risk factor in Poland. According to experts, low effectiveness in achieving therapeutic goals in dyslipidemia is associated with: the use of too low doses of statins, the selection of drugs with weak hypolipidemic effects, short treatment period, unjustified discontinuation of therapy and too rare use of combination therapy. As shown in numerous studies, adding ezetimibe to any statin is associated with a significant reduction in LDL cholesterol concentration and more frequent achievement of target lipid values than in the case of statin monotherapy. Optimization of hypolipidemic therapy and persistence in its use results in reduction of circulatory complications risk, which should be particularly emphasized in patients with high and very high cardiovascular risk. The paper presents 8 advantages of ezetimibe, with particular emphasis on its efficacy and safety of use and its place in modern therapy for lipid disorders.

Rivaroxaban – an effective drug for multiple indications and in diverse patient groups

2025-08-08T18:01:35+02:00

Rivaroxaban, a direct oral anticoagulant, is used for thromboembolic prevention and treatment. It is the only direct oral anticoagulant recommended for dual therapy in chronic coronary syndrome, peripheral artery disease, and post-acute coronary syndrome. Its pharmacokinetics and safety profile make it suitable for elderly patients, those with chronic kidney disease, and low body weight. In contrast, a once-daily dosage makes it suitable for young patients. The article discusses its use in atrial fibrillation, post-stroke, diabetes, and secondary thrombosis prevention.

Etoricoxib for pain management in a general practitioner’s office

2025-08-08T18:01:22+02:00

Etoricoxib – a selective cyclooxygenase 2 inhibitor – was introduced to therapy almost 20 years ago. It has proven to be an effective anti-inflammatory and analgesic drug for many chronic diseases of the musculoskeletal system, especially osteoarthritis and rheumatoid arthritis. The study includes the most important aspects of etoricoxib therapy, including indications, pharmacodynamics, pharmacokinetics and potentially new applications. The collected experience supported by the results of clinical studies should help to adapt the therapy of inflammatory pain to the individual needs of a specific patient. The ultimate goal of the study is to make etoricoxib therapy even more effective and even safer in the practice of a family doctor.

Seven steps of sitagliptin – therapeutic guide for practicing physician

2025-08-08T18:01:34+02:00

Sitagliptin is the most commonly used representative of dipeptidyl peptidase 4 (DPP-4) inhibitors, known as gliptins. According to current guidelines of the Diabetes Poland, DPP-4 inhibitors are component of type 2 diabetes mellitus therapy at the stage of initiating monotherapy, in the case of metformin intolerance, or at the stage of therapy intensification to achieve glycemic goals, while simultaneously providing patient education and behavioural management. Thanks to good tolerability, lack of significant side effects, and a safe cardiovascular profile, sitagliptin can be combined with other antihyperglycemic drug groups, including insulin, also in patients with chronic kidney disease. Therapeutic guide highlights potential applications of sitagliptin in the clinical practice.

Postinfection cough. Mechanisms, diagnostic challenges and the role of levodropropizine

2025-08-08T18:01:33+02:00

Post-infectious cough is defined as a persistent cough lasting from 3 to 8 weeks after a respiratory tract infection. It is emphasized that post-infectious cough poses a diagnostic and therapeutic challenge and can lead to chronic fatigue, insomnia, and many other ailments.

The article describes in detail the pathophysiology of post-infectious cough, focusing on the role of changes in the nervous system of the airways induced by viral infections and on the hyperreactivity of the airway nervous system. It also discusses the clinical presentation and differential diagnosis, which is crucial for excluding other causes of chronic cough, such as asthma, other allergic diseases, or gastroesophageal reflux.

Particular attention is paid to levodropropizine, a peripherally acting antitussive drug that inhibits the activity of C fibers responsible for the cough reflex. The results of a clinical trial from 2024 are cited, which demonstrated the effectiveness of levodropropizine in the treatment of acute post-viral cough in children. It is emphasized that the drug is well-tolerated and has few side effects. In summary, levodropropizine may be an effective and safe therapeutic option for the treatment of acute post-infectious cough, especially in children. However, it is noted that in the case of chronic cough, a thorough differential diagnosis is necessary.

Cyclosporine – indications in dermatology

2025-08-08T18:01:32+02:00

Cyclosporine A is a drug that has been used in clinical practice for over 50 years, but is still underestimated in many aspects. The multitude of clinical experiences related to the use of cyclosporine A, along with excellent knowledge of its safety profile and possible side effects, allows for fully informed and safe use of the drug and selection of a dose appropriate to the patient’s profile. This article presents examples of cyclosporine A use in dermatology.

Citalopram in clinical practice

2025-08-08T18:01:31+02:00

Citalopram is one of selective serotonin reuptake inhibitors, with well-documented efficacy in the treatment of major depressive disorder, as well as generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, premenstrual disorders and agitation in patients with dementia. The effect of citalopram was also assessed in patients with schizophrenia or alcohol use disorder. The aim of this work is to summarize the currently available data on the pharmacokinetics, pharmacodynamics, efficacy and safety as well positioning the role of citalopram in every day psychiatric clinical practice.

Ten reasons for choosing bilastine in 2025

2025-08-08T18:01:30+02:00

Bilastine is a novel non-sedating histamine H1-receptor antagonist developed for the treatment of allergic rhinoconjunctivitis and urticaria. Bilastine has a similar efficacy to other second-generation H1-receptor. Studies in human volunteers demonstrated that bilastine is rapidly absorbed after oral treatment, reaching maximal plasma concentrations 1–1.5 h after administration. The absorption of bilastine is linear and dose-proportional; it appears to be safe and well tolerated. Multiple administration of bilastine has confirmed the linearity of the kinetic parameters. The safety profile in terms of adverse effects is very similar to placebo. The distribution in the brain is undetectable. Bilastine 20 mg does not increase alcohol effects and is similar to placebo in the driving test. Bilastine is still the newest oral antihistamine in 2025, and after 15 years of use, we have a large number of new clinical trials and observational studies confirming its therapeutic efficacy and safety.

Current and potential areas of use of bupropion – a review of the literature

2025-08-08T18:01:29+02:00

A review of meta-analyses and systematic reviews on bupropion for the period 2020–2025 was conducted. Of the 135 publications found, 25 describing current and potential uses of this drug in psychiatry were selected. Bupropion is particularly valuable as an adjunct to antidepressant treatment in terms of efficacy (improvement of neurocognitive function, drive, breaking drug resistance) and improving tolerability (improving sexual function, reducing weight gain) and perhaps accelerating the antidepressant effect. A separate thread is the use of bupropion in addiction. With the growing number of addictions, including behavioral addictions, further research in this area is to be expected.

Eplerenone in heart failure

2025-08-08T18:01:28+02:00

Eplerenone, a selective mineralocorticoid receptor antagonist, plays a crucial role in the treatment of patients with heart failure with reduced ejection fraction. Its use reduces the risk of hospitalization and mortality in this patient group. Consequently, according to the guidelines of the European Society of Cardiology, mineralocorticoid receptor antagonist therapy is recommended as a Class I treatment for patients with heart failure with reduced ejection fraction, as well as for those who have experienced a myocardial infarction with a left ventricular ejection fraction ≤40% and coexisting heart failure or diabetes. An important advantage of eplerenone is its antifibrotic effect, which may help reduce the risk of arrhythmias, including atrial fibrillation. Additionally, due to its greater selectivity for mineralocorticoid receptors, eplerenone is associated with a lower risk of adverse effects compared to spironolactone.

Use of atomoxetine as the drug of choice in adults with ADHD in clinical practice

2025-08-08T18:01:27+02:00

This article discusses key aspects of initiating and monitoring ADHD treatment in specific groups of patients in whom, due to characteristic features in the medical history, non-stimulant treatment, primarily atomoxetine, may be the preferred choice. The pharmacology of atomoxetine, its mechanism of action, pharmacokinetics, dosage, and most common adverse effects are presented. Its usefulness in patients with ADHD comorbid with anxiety disorders, depression, history of alcohol dependence, risk of psychostimulant abuse, tics, and hoarding disorder is emphasized. Three case studies (patients with a history of alcohol dependence, anxiety after psychostimulants, and abuse of prescription psychostimulants) illustrate the practical application of atomoxetine in these specific clinical situations. In summary, atomoxetine is a valuable pharmacological option for the treatment of ADHD in adults, especially where psychostimulants are contraindicated or their use is associated with increased risk.

When the diagnosis of depression is not obvious. Patient cases

2025-08-08T18:01:26+02:00

A patient who is ultimately diagnosed with depression may report to a primary care physician due to a variety of symptoms and problems that mask a depressive syndrome. Cases of people with depressive pseudodementia, dominant irritability after a heart attack, and chronic pain are discussed. Diagnostic and therapeutic guidelines that may prove helpful in primary care are presented.

Differences in action profile between escitalopram and sertraline – theory and practice

2025-08-08T18:01:25+02:00

Currently, serotonin reuptake inhibitors are the first-line drugs in the treatment of depressive disorders and are the most commonly used group of antidepressants. Despite years of experience and extensive knowledge of the clinical characteristics of this group of drugs, distinguishing how individual serotonin reuptake inhibitors differ in their profile of action can be difficult even for experienced clinicians. In this article, we decided to look at the two most commonly used serotonin reuptake inhibitors – escitalopram and sertraline, and address both the differences in receptor activity and the antidepressant profile of both of these drugs. We hope that the information presented on the pharmacological action will allow for a better understanding of the differences in clinical action indicated in the article.

Preterm birth – use and role of progesterone

2025-08-08T18:01:24+02:00

Progesterone plays a key role in maintaining pregnancy, including preventing preterm birth. Vaginal progesterone is an effective drug for the prevention of preterm birth. Both in pregnant women with singleton gestation with a cervical length of ≤ 25 mm and in patients after effective tocolytic treatment in preterm labor, progesterone therapy reduces the risk of preterm delivery and, therefore, also the risk of low birth weight of the newborn and prematurity. Among the available gestagens, only vaginal progesterone has been proven effective in preventing preterm birth and is recommended by the Polish Society of Gynecologists and Obstetricians.

Combination therapy with tamsulosin and solifenacin in the treatment of patients with severe lower urinary tract symptoms associated with benign prostatic enlargement

2025-08-08T18:01:23+02:00

The combination of solifenacin and tamsulosin represents a promising therapeutic option for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia, particularly in cases of coexisting severe storage phase symptoms or overactive bladder syndrome. Combined therapy allows for the simultaneous reduction of lower urinary tract symptoms from both storage and voiding phases, which is crucial for improving patients’ quality of life. An additional advantage is the single-tablet formulation of the solifenacin and tamsulosin, which may enhance patient compliance and treatment efficacy.