Posted as supplied by author

e-Table. Bedside scenarios for which treatment decisions should be based on a detailed evaluation of the benefit to harm balance

A. When there is a narrow margin between benefit and harm
A1. Treatment is of modest or uncertain benefit, with some possibility of harm.	Aspirin for primary prevention of cardiovascular events in a healthy patient, bearing in mind the increase in gastrointestinal haemorrhage Antibiotics for sore throat and upper respiratory tract infections, given the possibility of antibiotic induced diarrhoea and rash, and the development of microbial resistance. Alosteron for irritable bowel disease, bearing in mind the controversy surrounding the adverse effect of ischaemic colitis
A2. Treatment has considerable potential for benefit, but there are major safety concerns	Aspirin for a patient with a stroke, but who has a past history of gastrointestinal haemorrhage An angiotensin converting enzyme inhibitor in a patient with severe heart failure who has moderate renal impairment, bearing in mind the possibility of drug- induced deterioration in renal function Metformin in an obese patient with type II diabetes mellitus and renal insufficiency; risk of lactic acidosis
A3. Potentially beneficial in the long term or to the community, but no immediate direct benefit to the individual	Improving the uptake of a childhood vaccine to promote herd immunity, while trying to assuage parental fears about serious adverse effects
A4. Lifestyle treatments	Finasteride for the treatment of male pattern baldness; erectile dyfunction is a recognized adverse effect.
B. When there is more than one efficacious treatment with differing safety profiles
B1. Treatments are of equivalent efficacy, but one agent may have a better safety profile	Selective cyclo-oxygenase-2 (COX-2) inhibitors rather than conventional non- steroidal analgesics in reducing the risk of gastrointestinal ulcer complications Antiepileptic drugs for a patient with epilepsy who plans to become pregnant Warfarin or ximelagatran in an elderly patient with atrial fibrillation
B2. Relative benefits and harms differ substantially among the available treatments; e.g. the most efficacious drug may have serious adverse effects, while the least effective agent is safer	Warfarin or aspirin in a healthy middle aged man with lone atrial fibrillation Dopamine receptor agonists or levodopa in patients with early stage Parkinson’s disease Disease-modifying drugs in a patient with newly diagnosed erosive rheumatoid arthritis; e.g. deciding between hydroxychloroquine (relatively safe) and methotrexate (potentially more effective, but less safe)
C. When a patient has difficulty continuing the medication because of adverse effects
C1. Treatment is of considerable benefit but the patient is troubled by adverse effects	A patient with severe heart failure has responded well to an ACE inhibitor, but now complains of cough; which is the best option - trying a lower dose or changing to an angiotensin receptor blocker?