DynaMed Weekly Update

April 28, 2009

Volume 4 Issue 17

DynaMed Systematic Literature Surveillance

For the week ending April 24, 2009

This week, 594 articles were considered for inclusion in DynaMed and 251 met criteria for inclusion.

The “article most likely to change clinical practice” this week relates to the swine influenza outbreak.

WHO and CDC Recommendations on Swine Influenza

In response to the current swine influenza outbreak, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have each issued interim guidelines. Most of the recent cases have occurred in otherwise healthy young adults without direct swine exposure. As of April 28, 2009, 26 confirmed cases have been reported in Mexico including 7 deaths. The United States has 64 confirmed cases, primarily in New York City. There have been 6 confirmed cases in Canada, 2 in Spain, 2 in the United Kingdom, 2 in Israel and 3 in New Zealand. No deaths have been reported outside Mexico. The DynaMed topic, Swine influenza, will be regularly updated as new information becomes available.

Antiviral resistance testing reported by the CDC finds 100% susceptibility to oseltamivir (Tamiflu) or zanamivir (Relenza) and 100% resistance to adamantanes (amantadine or rimantadine). This is different from antiviral susceptibility patterns for seasonal influenza, so sub-typing of influenza specimens is recommended in patients with influenza. CDC interim guidance for confirmed, probable or suspected cases of swine flu recommends 5-day treatment with either oseltamivir, 75 mg twice daily orally (weight-based dosing for children < 13 years old) or zanamivir, 10 mg twice daily via inhaler for adults and children > 7 years old.

Antiviral chemoprophylaxis (pre-exposure or post-exposure) with either oseltamivir or zanamivir may be indicated for individuals at high-risk of influenza complications, travelers to Mexico, workers at the Mexican border and healthcare workers with unprotected close contact with confirmed cases CDC Interim Guidance on Infection Control and Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts). Interim guidance is also available from the World Health Organization (WHO). A patient handout with general information about swine influenza is available from EBSCO Publishing Health Library.

For more information, see the Swine influenza topic in DynaMed.

For the latest evidence-based influenza-related information available for free, visit www.ebscohost.com/flu.

DynaMed Topic Activity

New summaries added to DynaMed this week:

· Antibiotics for adult inpatients with community-acquired pneumonia

· Antibiotics for adult outpatients with community-acquired pneumonia

· Antibiotics for pediatric inpatients with community-acquired pneumonia

· Antibiotics for pediatric outpatients with community-acquired pneumonia

· Probiotics for irritable bowel syndrome

· Steroids for pharyngitis

· Swine influenza

· Upper extremity deep vein thrombosis

DynaMed Peer Review

We are currently seeking reviewers for:

· Probiotics for irritable bowel syndrome

· Upper extremity deep vein thrombosis

For more information, see Editorial Policies for Authors & Reviewers and DynaMed Peer Review.

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DynaMed Weekly Update is a compilation of 1 to 5 articles that are of significant interest to clinicians. Articles are selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice. Updates are prepared by the DynaMed Editorial Team which includes 28 clinicians from multiple disciplines. Send comments to DynaMedEditor@epnet.com. To learn more about DynaMed, go to www.dynamicmedical.com.

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Copyright © 2009 EBSCO Publishing. All rights reserved.
DynaMed® is a registered trademark of and published by DynaMed LLC. Original date of on-line publication December 15, 1995 with continuous daily updating. ISSN: 1554-1177. Subscriptions and queries can be addressed to DynaMed LLC, EBSCO Publishing, 10 Estes St., Ipswich, Massachusetts, USA 01938-0602, telephone (978) 356-6500, facsimile (978) 356-6565, e-mail Editor@DynamicMedical.com. The opinions expressed herein are solely those of the authors and editors and may or may not represent the official position of cooperating or endorsing Medical Societies. Development of DynaMed was supported in part by the National Science Foundation through a Small Business Innovative Research grant. (All other support comes from subscriptions. No advertisements are accepted.)