DynaMed Plus® is a clinical reference tool that physicians visit for answers, with content written by a team of physicians and methodologists who synthesize medical evidence and provide objective analysis. In 2018, clinicians viewed the DynaMed Plus website and mobile app over seven million times to reference information at the point-of-care.
Here are the top viewed DynaMed Plus topics in 2018. Notably, all three have been published in collaboration with the American College of Physicians (ACP).
Uncomplicated urinary tract infection (UTI)
UTI is one of the most common bacterial infections worldwide, affecting about 150 million people annually. Because it is seen so frequently in both inpatient and outpatient settings, it’s no wonder that it was the most viewed topic of 2018. Many physicians searching DynaMed Plus for UTI are often looking to answer one of these clinical questions:
1. Does my patient require treatment?
Uncomplicated UTI refers to acute cystitis or pyelonephritis in a healthy, premenopausal, nonpregnant woman without underlying urinary tract abnormalities. As such, uncomplicated UTI should be treated with an appropriate antibiotic. However, management decisions will differ for patients with asymptomatic bacteriuria, complicated UTI, catheter-associated UTI, or fungal UTI, as well as UTI in men or children.
2. When is it appropriate to initiate treatment of asymptomatic bacteriuria?
Asymptomatic bacteriuria refers to isolation of a defined minimum quantity of bacteria (most often 10 5 colony-forming units/mL) in a urine specimen from a patient without signs or symptoms of UTI. Most patients with asymptomatic bacteriuria do not require treatment unless they are pregnant or about to undergo a urologic procedure.
3. Which antibiotic should be used for treatment of uncomplicated UTI?
The choice of antibiotic depends on whether the patient has cystitis or pyelonephritis, as well as local practice, resistance prevalence, availability, cost, and other patient factors such as allergy. International and region-specific guidance on antibiotic selection in patients with uncomplicated UTI can be found in DynaMed Plus.
Visit DynaMed Plus Uncomplicated UTI for more information and to read the full topic.
While physicians may frequently check DynaMed Plus for clinical questions related to diagnostic testing or treatment options, they don’t often have to look up the definition of a condition — except in the case of hypertension. Controversy over what blood pressure threshold constitutes hypertensive and requires therapy is at the heart of why the DynaMed Plus hypertension topic ended the year as the second most viewed topic in 2018.
Hypertension refers to the sustained elevation of systemic arterial blood pressure, which is associated with increased risk for heart disease, stroke and death. Hypertension is most often defined as systolic blood pressure (SBP) ≥ 140 mm Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg, but definitions vary by professional organization. In 2018, the American College of Cardiology/American Heart Association (ACC/AHA) blood pressure guideline lowered its recommended threshold to < 130/80 mm Hg, raising concerns about over-diagnosis and over-treatment.
Notably, the evidence for targeting blood pressure to the lower threshold comes primarily from a systematic review limited by clinical heterogeneity (J Am Coll Cardiol 2018). Specifically, the reduction in stroke risk in this systematic review was largely driven by a single trial of patients with type 2 diabetes, suggesting that a lower blood pressure target may be beneficial to patients with type 2 diabetes, but may not be applicable to a broader patient population.
Initial treatment for hypertension should always include lifestyle modification such as physical activity, weight reduction and smoking cessation. The decision to start medical therapy should be individualized with shared decision making that includes evaluation and discussion of estimated 10-year cardiovascular risk, risk reduction from medications, adverse effects and burden of medications, comorbidities and patient’s values and preferences.
Visit DynaMed Plus Hypertension for more information and to visit the full topic.
Community-acquired pneumonia in adults
Community-acquired pneumonia is a lower respiratory tract infection not associated with exposure in a healthcare setting (e.g. in contrast to hospital-acquired pneumonia or ventilator-associated pneumonia). It is among the most common causes of mortality worldwide, thus landing as the third most viewed topic in 2018.
Community-acquired pneumonia may be caused by a variety of pathogens including respiratory viruses such as rhinovirus and influenza virus, and bacteria such as Streptococcus pneumoniae and Mycoplasma pneumoniae, or even be caused by a mixed coinfection. Physicians encountering community-acquired pneumonia frequently look to DynaMed Plus to answer questions about empiric treatment options when infectious agent is unknown.
The Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) recommendations for therapy of community-acquired pneumonia varies based on severity of disease and treatment setting, risk factors for severe disease, and likelihood of infection with drug-resistant organisms. Empiric antimicrobial options, dosing, and duration for adults with community-acquired pneumonia can be found in DynaMed Plus.
Visit DynaMed Plus Community-acquired pneumonia in adults for more information and to view the full topic.