August 22, 2012Volume 7 - Issue 34   

DynaMed Weekly Update

For the week ending August 17, 2012

Last week 640 articles were evaluated via DynaMed's Systematic Literature Surveillance and 296 were added to DynaMed content.   


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Ciprofloxacin for 7 days May Be as Effective as 14 days For Clinical Cure of Acute Pyelonephritis in Women    


Oral ciprofloxacin for 7-10 days is a first-line treatment for uncomplicated acute pyelonephritis in nonpregnant women recommended by the Infectious Diseases Society of America and European Society for Microbiology and Infectious Diseases. This recommendation is based in part on a randomized trial that compared ciprofloxacin for 7 days vs. co-trimoxazole for 14 days (JAMA 2000 Mar 22-29;283(12):1583). That trial enrolled young women (median age 25 years) with mild to moderate illness, and the study population was found to have a high prevalence of co-trimoxazole resistance.  Treatment duration > 7 days remains common, but longer treatment is associated with increased risk of developing resistance. A new randomized noninferiority trial evaluated the generalizability of 7-day treatment with ciprofloxacin in an older and sicker population.


A total of 248 women (median age 43 years) with a preliminary diagnosis of acute pyelonephritis were randomized to receive ciprofloxacin 500 mg orally twice daily for 7 days vs. 14 days. The first week of treatment was open-label, and the second week was placebo-controlled. 69 women were excluded from the study for incorrect diagnosis, drug resistance, or other ineligibility, and an additional 23 women were excluded from analysis for loss to follow-up or other protocol violations. Bacteremia was present in 27%.


The primary outcome was clinical cure, defined as complete resolution of symptoms during treatment with no recurrence of symptoms or signs of urinary tract infection during follow-up. The clinical cure rates at 10-14 days were 97% with 7-day treatment and 96% with 14-day treatment (noninferiority established) (level 2 [mid-level] evidence). At 42-63 days, both groups had a clinical cure rate of 93% (noninferiority established). There was no significant difference in overall rates of adverse events, but 7-day treatment was associated with lower incidence of mucosal candida infection after the first week (0% vs. 5%, p = 0.036) (Lancet 2012 Aug 4;380(9840):484).


For more information, Acute pyelonephritis see the topic in DynaMed.

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DynaMed Extra
New CDC Guidelines for Treatment of Gonococcal Infections Do Not Recommend Oral Cephalosporins 


The Centers for Disease Control and Prevention (CDC) have released a new focused update to their guideline for the treatment of gonococcal infections (MMWR Morb Mortal Wkly Rep 2012 Aug 10;61:590-4 ). Oral cephalosporins (cefixime) are no longer recommended as first-line treatment. Current recommended treatment includes intramuscular ceftriaxone 250 mg plus either a single dose of oral azithromycin 1 g or oral doxycycline 100 mg twice daily for 7 days.


For more information, see the Gonococcal cervicitis, Gonococcal urethritis and related topics in DynaMed.

New Topics added to DynaMed this Week
Call for Peer Reviewers

We are currently seeking reviewers for:

Tumor lysis syndrome 

Dense deposit disease 


Learn more about the DynaMed Contribution Opportunities:

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: Augusts 22, 2012
Expiration Date: August 22, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.


No commercial support has been received for this activity.

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ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.


Program ID: 1102072Y

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