October 24, 2012Volume 7 - Issue 43        

DynaMed Weekly Update

For the week ending October 19, 2012

Last week 607 articles were evaluated via DynaMed's Systematic Literature Surveillance and 316 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

Oral Prednisolone Might Not Improve Acute Rhinosinusitis Symptoms


Oral corticosteroids are sometimes prescribed for symptom relief in patients with acute rhinosinusitis. In a Cochrane review (Cochrane Database Syst Rev 2011 Dec 7;(12):CD008115) steroids were associated with some symptom improvement, but most of the patients in the included trials had been referred for specialist care and had radiologic assessment as part of diagnostic testing. The benefit of corticosteroids in primary care management of sinusitis remains unclear. A recent randomized trial evaluated oral prednisolone in 185 adults with uncomplicated acute rhinosinusitis who visited their primary care physician.


Patients (mean age 43 years) with sinusitis symptoms for at least 5 days were randomized to prednisolone 30 mg/day orally vs. placebo for 7 days. All patients had either nasal discharge or congestion and had facial pain or pressure (or pain when chewing). They were allowed to take acetaminophen as needed. Participating physicians were allowed to prescribe antibiotics or nasal corticosteroids, but were asked to refrain from doing so for the first 7 days whenever possible. Patients were asked to fill out a symptom diary for 14 days.


In analysis of 94% of the randomized patients, there were no significant differences in symptom outcomes (level 2 [mid-level] evidence). In the prednisolone group, 62.5% had complete resolution of facial pain or pressure at 7 days compared to 55.8% in the placebo group. The median duration of facial pain was 4.5 days with prednisolone vs. 5 days with placebo. The rates of total symptom resolution at 7 days were 32.9% with prednisolone vs. 25.3% with placebo. There were no significant differences in health related quality of life or adverse events at 7 or 14 days or in symptoms in long-term follow-up at 8 weeks (CMAJ 2012 Oct 2;184(14):E751). 


The trial was powered to detect a 20% difference in the rates of pain resolution at 7 days, but the observed difference was only 6.7%, and the trial was underpowered to establish this degree of difference as statistically significant.  Whether a difference of this magnitude would warrant the use of corticosteroids involves considerations of both the patient's and clinician's values and preferences. This clinical decision-making may depend on the severity of the symptoms, the patient-specific risks associated with corticosteroids, and the alternative options considered.

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

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New Topics Added to DynaMed this Week 
Clostridium difficile infection in children
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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: October 24, 2012
Expiration Date: October 24, 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; Senior 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: 1102073H

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