October 30, 2013

DynaMed EBM Journal Volume 8, Issue 44

DynaMed Weekly Updates

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: October 30, 2013

Expiration Date: October 30, 2014

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.

Accreditation Statements

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 EducationCompany 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 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed EBM Focus, 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 EBM Focus 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: 1210393Y


Last week 685 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 226 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Probiotics May Not Reduce Antibiotic-Associated Diarrhea in Elderly Inpatients
Reference: PLACIDE trial (Lancet 2013 Oct 12;382(9900):1249) (level 2 [mid-level] evidence)

Probiotic preparations have been widely investigated for prevention of antibiotic-associated diarrhea and Clostridium difficile diarrhea under the theory that augmenting the gut flora may restore pathogen resistance disrupted by antibiotic treatment. A recent Cochrane review (Cochrane Database Syst Rev 2013 May 31;(5):CD006095) provided moderate-quality evidence that probiotics were effective against antibiotic-associated diarrhea in children and adults. However, most of the 31 included trials had relatively small sample sizes and were conducted at single centers, and few individual trials showed significant risk reduction. Furthermore, few trials have specifically addressed the efficacy of probiotics in elderly patients. Now, the PLACIDE trial, a multicenter randomized trial, roughly the size of the entire population included in the Cochrane review, has evaluated the efficacy of a probiotic preparation in 2,981 elderly inpatients in England.

Hospitalized patients ≥ 65 years old (mean age 77 years) who were taking at least 1 oral or parenteral antibiotic were randomized to a probiotic preparation with Lactobacilli acidophilus plus Bifidobacteria bifidum orally once daily for 21 days vs. placebo and were followed for 8 weeks. All patients had taken antibiotics within 7 days or were about to start antibiotic treatment, and the indications for antibiotics were similar between groups (most common indications were respiratory, thoracic and mediastinal disorders, surgical and medical procedures, and renal and urinary disorders). Antibiotics given included penicillins in 72%, cephalosporins in 24%, and quinolones in 12%. .

Adherence to the allocated treatment was low, with only about 53% of patients in each group taking all 21 doses. The incidence of antibiotic-associated diarrhea at 3 weeks was 10.8% with probiotics vs. 10.4% with placebo (not significant), and the incidence of C. difficile diarrhea was 0.8% vs. 1.2% (not significant). The median hospital stay in each group was 4 days. There were no significant differences in duration or severity of either antibiotic-associated diarrhea or C. difficile diarrhea, or in serious adverse events or quality of life.

For more information, see the Probiotics to prevent antibiotic-associated diarrhea topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

DynaMed Events

American College of Rheumatology (ACR), October 25 - 30, 2013
Representatives will be attending the ACR conference, held at the San Diego Convention Center in San Diego, California. Stop by booth 1807 to discuss peer review, mobile access, and free trial information.

Visit the ACR website to learn more about the event and for registration information.

Family Medicine Education Consortium (FMEC) Northeast Regional Meeting, November 1 - 3, 2013
Deputy Editor Tom Hilts, DO will be attending the FMEC conference, held at the Sheraton Downtown Hotel in Philadelphia, Pennsylvania. Representatives will be available to discuss peer review, mobile access, and free trial information.

Dr. Hilts will also be presenting the following sessions:

  • Engaging Faculty and Residents in Scholarly Activity: Electronic Peer Review of Evidence (S63a Salon 4)
    Presented by Michael Mendoza MD, MPH, MS, Thomas Hilts, DO, and Robbyn Upham, MD
  • Simple Solutions for Residents to Author Peer-Reviewed Publications (S63b Salon 4)
    Presented by Thomas Hilts, DO, Michael Mendoza MD, MPH, MS, and Christian Vanderkaay, MD

  • Visit the FMEC website to learn more about the event and for registration information.

    Kidney Week, November 5 - 10, 2013
    Representatives will be attending Kidney Week, held at the Georgia World Congress Center in Atlanta, Georgia. Visit booth 1231 to discuss peer review, mobile access, and free trial information.

    Visit the Kidney Week website to learn more about the event and for registration information.

    If you would like to meet with a DynaMed representative at an event, please contact us at DynaMedCommunity@ebscohost.com.

    Call for Peer Reviews

    We are currently seeking reviewers for:

    Myocardial bridging

    Congenital long QT syndrome

    DynaMed Careers

    Looking for a change? The DynaMed editorial team is expanding and looking for talented and driven individuals. Visit the links below to learn about these exciting opportunities.

    Medical Writer
    Medical Editor
    Associate Editor