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    Nitrofurantoin: what is the evidence for current UK guidance?
    (Oxford University Press, 2023-11-06) Kashouris, E.; Joseph, A.; Lewis, T.
    Three days of nitrofurantoin at 100 mg twice daily is recommended as first-line treatment for uncomplicated urinary tract infection (UTI) in evidence-based guidelines across the UK. A review of international guidelines shows that the evidence base has been interpreted in very different ways. UK guidelines are unusual in promoting short (3 day) courses, and we find little direct evidence to support this. Although 'short' courses of antibiotics for other agents may provide optimum balance between providing effective treatment whilst reducing selective pressure driving resistance amongst colonizing microbial flora, it remains unclear that course lengths can be extrapolated to nitrofurantoin. Three days of nitrofurantoin may indeed be a useful intervention in a large group of patients. However, without supporting evidence and because clinical response should be expected to vary widely, it is unclear that establishing and promoting an antibiotic duration for UTI is the best approach to optimizing prescribing in this important area.
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    Update of the international HerniaSurge guidelines for groin hernia management
    (Wiley, 2023-09-05) Stabilini, C.; van Veenendaal, N.; Aasvang, E.; Agresta, F.; Aufenacker, T.; Berrevoet, F.; Burgmans, I.; Chen, D.; de Beaux, A.; East, B.; Garcia-Alamino, J.; Henriksen, N.; Köckerling, F.; Kukleta, J.; Loos, M.; Lopez-Cano, M.; Lorenz, R.; Miserez, M.; Montgomery, A.; Morales-Conde, S.; Oppong, C.; Pawlak, M.; Podda, M.; Reinpold, W.; Sanders, D.; Sartori, A.; Tran, H. M.; Verdaguer, M.; Wiessner, R.; Yeboah, M.; Zwaans, W.; Simons, M.
    BACKGROUND: Groin hernia repair is one of the most common operations performed globally, with more than 20 million procedures per year. The last guidelines on groin hernia management were published in 2018 by the HerniaSurge Group. The aim of this project was to assess new evidence and update the guidelines. The guideline is intended for general and abdominal wall surgeons treating adult patients with groin hernias. METHOD: A working group of 30 international groin hernia experts and all involved stakeholders was formed and examined all new literature on groin hernia management, available until April 2022. Articles were screened for eligibility and assessed according to GRADE methodologies. New evidence was included, and chapters were rewritten. Statements and recommendations were updated or newly formulated as necessary. RESULTS: Ten chapters of the original HerniaSurge inguinal hernia guidelines were updated. In total, 39 new statements and 32 recommendations were formulated (16 strong recommendations). A modified Delphi method was used to reach consensus on all statements and recommendations among the groin hernia experts and at the European Hernia Society meeting in Manchester on October 21, 2022. CONCLUSION: The HerniaSurge Collaboration has updated the international guidelines for groin hernia management. The updated guidelines provide an overview of the best available evidence on groin hernia management and include evidence-based statements and recommendations for daily practice. Future guideline development will change according to emerging guideline methodology.