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Started By
Message
re: Sitting in the doctor office with my kid, doctor wants to prescribe
Posted on 9/3/19 at 7:53 pm to YipSkiddlyDooo
Posted on 9/3/19 at 7:53 pm to YipSkiddlyDooo
Kid needs new dad.
1
Posted on 9/3/19 at 8:00 pm to Texas ellessu
Is this entire board nothing but trolls?. I clarified and even owned up to my mistake and still this shite?
Posted on 9/3/19 at 8:02 pm to Bedhog
Get a new doctor.
Posted on 9/3/19 at 8:09 pm to tigerfan4120
See that’s just not even true. Even though you are able to name all the centor criteria, even if you have a centor of 4, it’s still only about 50:50 chance of being GAS pharyngitis. There is currently no recommendation for empiric treatment of 4s, only testing. The centor criteria is meant to be used as a screening tool for who does not need testing, not for empirically treating.
Posted on 9/3/19 at 8:10 pm to Bedhog
quote:
I questioned the use of laxatives as ear cleanser as well.
I do not know why but I misread that and thought that she gave it by mouth.
quote:
Was told that it is pharmaceutical and does the job dislodging ear wax the best.
Olive oil works better.
This post was edited on 9/3/19 at 8:33 pm
Posted on 9/3/19 at 8:19 pm to The People
quote:Hmm.
Wife has been sick since Saturday, but tested negative for strep or flu. Hasn’t stopped her from being the miserable frick that she always is when she doesn’t feel well.
Posted on 9/3/19 at 8:23 pm to Bedhog
I would keep seeing that doctor. It’s rare to find a doctor who practices like that because of the reasons already mentioned. Meanwhile, most of the second and third world can pick up the phone and have their local pharmacy deliver a z pack or whatever, no doctor needed.
Posted on 9/3/19 at 8:26 pm to biglego
quote:
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.
This has to be a troll
Posted on 9/3/19 at 8:31 pm to Bedhog
quote:
Is this entire board nothing but trolls?. I clarified and even owned up to my mistake and still this shite?
You did not change it in the OP and you need to reword your OP. You are making people think that she did not test for bacterial pharyngitis caused by Streptococcus pyogenes (aka GAS) instead of acute otitis media likely caused by Streptococcus pneumoniae. The reason why the doctor did not test for Streptococcus pneumoniae is because it is part of the normal flora of the upper respiratory tract. The test is going to come back positive 100 out of 100 times.
Posted on 9/3/19 at 8:35 pm to Bedhog
quote:
Checked ears. Had fluid behind ear wax. Cleaned out ears with stool softener, irrigated 5 minutes afterwards. Called in a script for low dose Amoxicillin, Symbacort and Promethazine syrup.
Yeah your kid had a virus. Symbicort (inhaler I'm assuming) and promethazine aren't appropriate if just treating strep.
Posted on 9/3/19 at 8:36 pm to WeeWee
The FeverPain score did not perform well in its validation study which is likely why it is not recommended for use by societal guidelines.
likely docusate which is a reasonable choice for trying to soften up and remove ear wax - see older docs use this often.
quote:
Cleaned out ears with stool softener,
likely docusate which is a reasonable choice for trying to soften up and remove ear wax - see older docs use this often.
Posted on 9/3/19 at 8:57 pm to Bedhog
quote:
Get pissed that they are overcharging your insurance
its $58 no matter what tests they run.
That's not how this works. It's $58 for you, but unnecessary shite that doesn't come out of your pocket is a major problem in health care.
Posted on 9/3/19 at 9:07 pm to WaydownSouth
quote:
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
It's almost like they have limited knowledge of diseases and are wholly unqualified to practice on their own.
Posted on 9/3/19 at 9:25 pm to Bedhog
quote:
Is this entire board nothing but trolls?. I clarified and even owned up to my mistake and still this shite?
Posted on 9/3/19 at 9:25 pm to studentforlife
quote:
The FeverPain score did not perform well in its validation study which is likely why it is not recommended for use by societal guidelines.
Which is why you treat the patient and not the numbers. I said if the pt looks sick and has a high fever-pain score that kid is going on antibiotics. I have yet to have a pt with a high fever-pain score, looked sick, and have a negative rapid-strep test in my patients in the USA because usually if they look sick the rapid strept is positive and they are going on antibiotics. However if I do ever have a patient that looks sick and has a negative rapid strep then I am calculating that score and putting the kid on antibiotics because on my last mission trip to Ukraine, there was a 6 year old that had to have a mitral valve replacement because of untreated strep pharyngitis. A couple of days worth of antibiotics is not going to cause enough of change in resistance in that unlikely situation.
FYI I only linked it because I did not want to type out the different variables and I figured the nonmedical people could understand it that way.
quote:
likely docusate which is a reasonable choice for trying to soften up and remove ear wax - see older docs use this often.
I already owned up to it. I misread and thought that she gave it to him by mouth.
Posted on 9/3/19 at 9:51 pm to WeeWee
quote:
WeeWee
I generally agree with what you're saying, but the incidence of complications from strep throat infections is so low, compared to the rates of serious allergic reactions to the antibiotics we prescribe, that it's probably not worth prescribing abx to begin with in strep throat.
Possible complications of untreated or partially treated strep throat infection are:
quote:
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)
1. Rheumatic fever is super, super rare in the west. If you were practicing in a 3rd world country I would say treat every time. NNT is somewhere in the thousands, possibly millions, for the US population.
- You don't prevent post-streptococcal glomerulonephritis with antibiotic treatment
2. Otitis Media - you have a number needed to treat of 25 to >200 to prevent one case of AOM. Probably not worth the risk of the antibiotics.
3. Meningitis - I'll give you this one, but it's super rare and far more likely in someone from a third world country or someone who is immunocompromised.
4. TSS I'll give you again
5. To prevent one peritonsillar abscess you have a NNT of 28 to 55-225.
And on top of it all there is this:
quote:That's the Little who also performed the PRISM study from which the FeverPAIN rules are derived.
A more recent study demonstrated an overall suppurative complication rate of 1.3% and no difference in patients who received antibiotics versus those that did not (Little 2013).
quote:
The FeverPain score did not perform well in its validation study which is likely why it is not recommended for use by societal guidelines.
Yeah I had never heard of this one but it's interesting, but if the validation studies weren't great then I don't see it kicking Centor to the curb.
quote:
likely docusate which is a reasonable choice for trying to soften up and remove ear wax - see older docs use this often.
Am I the only person who was taught to use a 50:50 solution of water and hydrogen peroxide? The peds program where I trained would tell parents to put it on a cotton ball and shove it in the kid's ear before they go to bed.
This post was edited on 9/3/19 at 9:56 pm
Posted on 9/3/19 at 10:52 pm to cwil177
quote:
not worth prescribing abx to begin with in strep throat.
I am not talking about the average strep throat patient that PCPs see ten times a day. I am talking about the patient that has a high centor and/or fever-pain score + a negative strep test + looks really sick but not sick enough to be referred to the ED or admitted to the hospital. This is really getting into the hypothetical and stuff that you only see on Step 1 because the likelyhood of all of those happening together in the USA is really small because now that I think about it most docs would probably go ahead and send the pt to the hospital if they look that sick.
quote:
Rheumatic fever is super, super rare in the west.
I wonder why that is? Oh yeah it is because we have been prescribing antibiotics in the west. It is not common but it is also not uncommon to see pts with a history of rheumatic fever in the recent past (like within the last ten years) at the clinics that I have volunteered at in Ukraine.
quote:
f you were practicing in a 3rd world country
I am pretty sure that the rural WV town that one of the outpatient clinics qualifies as third world.
quote:
- You don't prevent post-streptococcal glomerulonephritis with antibiotic treatment
I did not make the list. I just copied and pasted it.
quote:
And on top of it all there is this:
quote:
A more recent study demonstrated an overall suppurative complication rate of 1.3% and no difference in patients who received antibiotics versus those that did not (Little 2013).
That's the Little who also performed the PRISM study from which the FeverPAIN rules are derived.
quote:
The FeverPain score did not perform well in its validation study which is likely why it is not recommended for use by societal guidelines.
Yeah I had never heard of this one but it's interesting, but if the validation studies weren't great then I don't see it kicking Centor to the curb.
Like I said earlier, I just posted the fever-pain because I did not want to type out all the different variables.
quote:
likely docusate which is a reasonable choice for trying to soften up and remove ear wax - see older docs use this often.
Am I the only person who was taught to use a 50:50 solution of water and hydrogen peroxide?
That is what we use in the clinic and that is why I initially assumed that the OP meant that the doc gave the pt a laxative by mouth which would turn an ear ache into a really crappy ear ache.
quote:
The peds program where I trained would tell parents to put it on a cotton ball and shove it in the kid's ear before they go to bed.
Put some olive oil in a visine bottle and it works miracles.
Posted on 9/3/19 at 10:59 pm to Bedhog
quote:Welcome to 2019. There is no forgiveness.
Is this entire board nothing but trolls?. I clarified and even owned up to my mistake and still this shite?
Posted on 9/3/19 at 11:38 pm to Bedhog
Centor Score
The MD knew he didn’t need to test based on this.
Look it up everybody and educate yourselves.
The MD knew he didn’t need to test based on this.
Look it up everybody and educate yourselves.
This post was edited on 9/3/19 at 11:45 pm
Posted on 9/3/19 at 11:47 pm to Chucktown_Badger
there is a lot of back and forth regarding this particular subject.
adhering to the "full course" of antibiotics (typically 7-10 days) is essentially practicing empirical medicine.
best evidence suggests discontinuing 24-48hrs after resolution of the symptoms for which the antibiotic was prescribed for.
IMHO, i'd say the bigger issue is overuse and prescribing antibiotics too readily when not indicated.
Just more food for thought...
adhering to the "full course" of antibiotics (typically 7-10 days) is essentially practicing empirical medicine.
best evidence suggests discontinuing 24-48hrs after resolution of the symptoms for which the antibiotic was prescribed for.
IMHO, i'd say the bigger issue is overuse and prescribing antibiotics too readily when not indicated.
Just more food for thought...
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