AFP Clinical Answers

Bone Infections, Sinusitis, Antihypertensive Therapy and COVID-19, Toilet Training, Amenorrhea


Am Fam Physician. 2020 Jun 15;101(12):718.

Are oral antibiotics as safe and effective as intravenous antibiotics for patients with bone and joint infections?

Oral antibiotics started within seven days of surgery in patients with a serious bone or joint infection are as safe and effective as six weeks of intravenous antibiotics. In a randomized controlled trial of 1,015 patients with osteomyelitis or infection of a native or artificial joint, switching to oral therapy within seven days made no difference in the rate of treatment failure and adverse events compared with six weeks of continuous intravenous antibiotics.

What treatments are effective for chronic sinusitis?

Saline irrigation helped somewhat in a randomized controlled trial, and an intranasal steroid does not add substantially more benefit. Saline irrigation alone may be effective for symptom control.

What is the association between antihypertensive medications and COVID-19?

Researchers used electronic health records to identify 12,594 patients who were tested for coronavirus disease 2019 (COVID-19) from March 1 to April 15, 2020. Based on a report published on May 1, 2020, 5,894 (46.8%) of the patients tested positive for COVID-19, and 1,002 of these (17.0%) had severe illness (i.e., intensive care unit admission, mechanical ventilation, or death). The high rate of positive results reflects highly selective ordering of tests, which makes comparisons with other settings challenging. A total of 4,357 (34.6%) of the patients tested had a history of hypertension, and 2,573 (59.1%) tested positive for COVID-19.

Antihypertensive medication use (i.e., angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, or thiazide diuretics) was higher in patients with COVID-19 than in patients with a negative test result. However, after accounting for known confounders, no association was found between any antihypertensive med



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