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College of Pharmacy

HelixTalk #199 - Axe the Anaerobes, Drop the Docuste, Free the Fluids

Date posted: September 18, 2026, 1:18 pm

In this episode, we review three medical myths, highlighted in the “Things We Do For No Reason” series of the Journal of Hospital Medicine, including anaerobic coverage for aspiration pneumonia, fluid restriction in heart failure, and docusate for constipation.

Key Concepts

  1. In aspiration pneumonia, addition of anaerobic coverage is not necessary unless a patient has necrotizing pneumonia, empyema, or lung abscess. Antibiotic selection should be aligned with CAP or HAP guidelines even if aspiration is suspected or observed.
  2. Docusate has not been shown to be more effective than placebo. Evidence-based and effective laxatives, such as PEG 3350 or psyllium, should be used instead.
  3. Patients with heart failure should not be fluid restricted unless they have hyponatremia. Excessive fluid should be treated with diuretics and optimization of guideline-directed medical therapy.

References

  • PubMed search for “Things We Do For No Reason” https://pubmed.ncbi.nlm.nih.gov/?term=%22Things+We+Do+for+No+Reason%22%5Btitle%3A%7E0%5D&sort=date
  • Vedamurthy A, Rajendran I, Manian F. Things We Do for No Reason™: Routine Coverage of Anaerobes in Aspiration Pneumonia. J Hosp Med. 2020;15(12):754-756. doi:10.12788/jhm.3506
  • Caton JB, Jimenez S, Wang SX. Things We Do for No Reason™: Fluid Restriction for the Management of Acute Decompensated Heart Failure in Patients With Reduced Ejection Fraction. J Hosp Med. 2021;16(12):754-756. doi:10.12788/jhm.3639
  • Herrmann JJ, Brunner-La Rocca HP, Baltussen LEHJM, et al. Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial. Nat Med. 2025;31(6):2062-2068. doi:10.1038/s41591-025-03628-4
  • Fakheri RJ, Volpicelli FM. Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults. J Hosp Med. 2019;14(2):110-113. doi:10.12788/jhm.3124
  • Rao SSC, Brenner DM. Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation: An Updated Systematic Review. Am J Gastroenterol. 2021;116(6):1156-1181. doi:10.14309/ajg.0000000000001222
  • Dioctyl Sulfosuccinate or Docusate (Calcium or Sodium) for the Prevention or Management of Constipation: A Review of the Clinical Effectiveness. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; June 26, 2014.