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Started By
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re: Sitting in the doctor office with my kid, doctor wants to prescribe
Posted on 9/3/19 at 5:47 pm to Bedhog
Posted on 9/3/19 at 5:47 pm to Bedhog
When you say something as stupid as
you will get this response
quote:
viruses may gain immunity to antibiotics
you will get this response
quote:
she seemed to take offence and basically made me feel bad
0
Posted on 9/3/19 at 5:51 pm to Bedhog
Take the antibiotics but try not to take all of them. The viruses build up immunity so give them as little as possible. Plus you can save the medicine for next time and save money that way. The meds don’t ever really expire.
Posted on 9/3/19 at 5:51 pm to Coatesbathroom
quote:
She may have been using the Centor Criteria to diagnose. If you have 5 points you can technically just prescribe antibiotics without the test depending on scenario. However, it is still recommended to consider performing the test/culture. She may also have been prescribing antibiotics not for strep but for a middle ear infection she may have seen on exam.
Recent studies show that if a patient has all 4 centor criteria they still only have a 50% chance of having GAS pharyngitis. This is why, as studentforlife elucidated, you should in most cases swab, rapid antigen test, and culture these patients. Vast majority of pharyngitis is viral, and even the exudates only portend a likelihood ratio for GAS of ~2, which isn’t really great.
R.E.B.E.L. EM did a great breakdown of whether or not abx are even indicated for possible strep here.
If podcasts are more your thing, the pediatric emergency medicine playbook also did an excellent review. LINK
The way things are going I think we may eventually stop treating pharyngitis in the US with antibiotics. Many up to date pediatricians also do not routinely treat middle ear infections with antibiotics as the vast majority are viral, however I think a “wait and see if it gets better” approach (giving parents an Rx and letting them decide to fill or not) is the best way to go. I tell my patients if their kids’ ears don’t feel better in the next 24-48 hours, or their pain isn’t well controlled with ibuprofen + Tylenol, then go ahead and give the antibiotics.
TL;DR: most cases of “strep” throat are viral and probably don’t need antibiotics anyway, and your kid probably got better over time regardless of the effect of the antibiotic.
Posted on 9/3/19 at 6:09 pm to cwil177
quote:
Many up to date pediatricians also do not routinely treat middle ear infections with antibiotics as the vast majority are viral, however I think a “wait and see if it gets better” approach (giving parents an Rx and letting them decide to fill or not) is the best way to go.
I agree with this approach, especially with reliable, reasonable parents, as many cases of acute otitis media will improve and resolve with analgesia alone. However, I don't think it has yet become the standard of care, and antibiotics still advocated for by my Peds, PEM, and Peds ID colleagues, but that may change in the future.
Posted on 9/3/19 at 6:13 pm to Bedhog
quote:
Antibiotics for strep without even running a test. Only visual inspection of ears and throat.
Sounds about right. Given the OP's limited and inconsistent details, I am trusting the judgement of the board certified physician.
quote:
Isn't it frowned upon by civility standards because of the fear that viruses may gain immunity to antibiotics to just go around throwing antibiotics prescriptions?
How is a virus going to gain immunity to an antibiotic?
quote:
I actually told the doctor this and she seemed to take offence and basically made me feel bad for questioning this.
You should feel bad. This is a classic example of why Dr. Google syndrome.
quote:
I realize Strep is not a virus.
You do know that there are more than one type of strep?
This post was edited on 9/3/19 at 8:15 pm
Posted on 9/3/19 at 6:15 pm to VolsOut4Harambe
quote:
Most GP's nowadays take one look at a patient and throw medicine at them.
For the most part, what is the point of a doctor other than access to drugs? Doctors can't cure illness with spit and polish.
Posted on 9/3/19 at 6:19 pm to Bedhog
Strep throat is a bacterial infection that needs antibiotics. If it is obvious enough on physical exam, we will save you money and just prescribe antibiotics instead of order an unnecessary test. If it isn't streptococcus pyogenes precisely, then the antibiotics should kill whatever bacteria is affecting the throat.
Don't frick with strep throat. It messes up your heart and can kill you.
Don't frick with strep throat. It messes up your heart and can kill you.
Posted on 9/3/19 at 6:21 pm to VolsOut4Harambe
I always chuckle when I see scripts from the urgent care clinics from NPs or PA’s. 90% of the time they give them a Z-pack and medrol dose pack. Its like the sick starter pack
Posted on 9/3/19 at 6:23 pm to FearTheFish
quote:
Strep vax?
Sign me up. That'd be awesome.
Posted on 9/3/19 at 6:45 pm to Bedhog
I go out of my way to find a doctor that will give antibiotics when you probably need them without waiting for a test.
Yes, over prescribing antibiotics helps breed resistant bacteria....
But if it is available over the counter in other countries, or routinely used with livestock, it is pissing in the wind and asinine to make me wait when I'm sick and (probably) need them!
Yes, over prescribing antibiotics helps breed resistant bacteria....
But if it is available over the counter in other countries, or routinely used with livestock, it is pissing in the wind and asinine to make me wait when I'm sick and (probably) need them!
Posted on 9/3/19 at 6:46 pm to Bedhog
You sound really dumb
A medical student could diagnose strep based off an H&P given the proper contextual details of the visit.
Antibiotics are given for bacterial infections.
Antibiotics are NOT given for viral infections. Vaccines can prevent some viral infections AND bacterial infections.
That's all you should worry about. Let the doctor with four years of medical school, four years of residency and multiple years of practice make the decisions for something as simple as this.
A medical student could diagnose strep based off an H&P given the proper contextual details of the visit.
Antibiotics are given for bacterial infections.
Antibiotics are NOT given for viral infections. Vaccines can prevent some viral infections AND bacterial infections.
That's all you should worry about. Let the doctor with four years of medical school, four years of residency and multiple years of practice make the decisions for something as simple as this.
Posted on 9/3/19 at 7:15 pm to Upperdecker
quote:
Yes, this is actually the exact practice they frown upon.
For run of the mill sore throats, runny nose, etc yes.
quote:
They’re supposed to run a strep sample and culture it to confirm presence of strep.
Supposed to =/= have to that is why they are called clinical guidelines and not clinical laws. IF the pt looks sick and has a FeverPain score of 4 or 5 then that is a 60-65% chance that kid has strep. The consequences though rare are too severe to f**k around with. I am calling in antibiotics. The only difference is if I have the nurse call and tell you that you can stop taking the antibiotics after 48-72 hours if the cultures came back negative.
quote:
I’d get a new doctor, especially if she gets mad when you question
$20 says the doctor did not get mad.
This post was edited on 9/3/19 at 8:52 pm
Posted on 9/3/19 at 7:21 pm to Bedhog
quote:
I'm not pretending to be a doctor so explain why the doctor was willing to prescribe them as a precautionary measure?
Glad that you asked.
quote:LINK
Possible complications of untreated or partially treated strep throat infection are:
1.Rheumatic fever Glomerulonephritis
2.Otitis media (spread of infection to the middle ear)
3.Meningitis (spread of infection to the lining of brain and spinal canal) Pneumonia (lung infection)
4.Toxic shock syndrome (a rare but severe complication of strep pharyngitis, causing severe widespread infection and organ failure)
5. Abscess formation around the tonsils and behind the throat (peri-tonsillar abscess and retro-pharyngeal abscess)
That is why.
Posted on 9/3/19 at 7:28 pm to Bedhog
You sound like a bad father
Posted on 9/3/19 at 7:37 pm to Bedhog
Run too many tests... Get pissed that they are overcharging your insurance
Run too few tests... Get pissed that they don't know what they are doing
Maybe she looked at you like a ratard because you said viruses will gain immunity to antibiotics
Run too few tests... Get pissed that they don't know what they are doing
Maybe she looked at you like a ratard because you said viruses will gain immunity to antibiotics
Posted on 9/3/19 at 7:39 pm to Bedhog
quote:
Checked ears. Had fluid behind ear wax.
1. That is otits media ( aka ear infection) not strep pharyngitis. You should mention that in the OP because that changes the entire discussion.
2. How long has your child been sick? Most cases are viral in origin but if it has lasted? Does your child appear sick as shite? How high was the fever?
quote:
Cleaned out ears with stool softener,
ETA: I misread that last part but I am leaving the gif.
This post was edited on 9/3/19 at 8:34 pm
Posted on 9/3/19 at 7:42 pm to WaWaWeeWa
quote:its $58 no matter what tests they run.
Get pissed that they are overcharging your insurance
Posted on 9/3/19 at 7:44 pm to WeeWee
I questioned the use of laxatives as ear cleanser as well. Was told that it is pharmaceutical and does the job dislodging ear wax the best. 
Posted on 9/3/19 at 7:46 pm to Elleshoe
quote:
You sound like a bad father
The absolute worst. Checked kid out from school to make sure other kids didn't become sick from my kid. Took the kid to the doctor that day.
The absolute worst
Posted on 9/3/19 at 7:48 pm to Upperdecker
quote:
Yes, this is actually the exact practice they frown upon. They’re supposed to run a strep sample and culture it to confirm presence of strep. I’d get a new doctor, especially if she gets mad when you question a legitimately bad practice
What is frowned upon is needless laboratory studies in the presence of a good physical exam. Or Rx'ing abx in the absence of any physical exam.
If I got advanced imaging on every MSK injury I treat, or cultures on every infection I see...I would waste even more healthcare dollars than I already do...
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