- My Forums
- Tiger Rant
- LSU Recruiting
- SEC Rant
- Saints Talk
- Pelicans Talk
- More Sports Board
- Fantasy Sports
- Golf Board
- Soccer Board
- O-T Lounge
- Tech Board
- Home/Garden Board
- Outdoor Board
- Health/Fitness Board
- Movie/TV Board
- Book Board
- Music Board
- Political Talk
- Money Talk
- Fark Board
- Gaming Board
- Travel Board
- Food/Drink Board
- Ticket Exchange
- TD Help Board
Customize My Forums- View All Forums
- Show Left Links
- Topic Sort Options
- Trending Topics
- Recent Topics
- Active Topics
Started By
Message
re: Sitting in the doctor office with my kid, doctor wants to prescribe
Posted on 9/4/19 at 12:02 am to WeeWee
Posted on 9/4/19 at 12:02 am to WeeWee
quote:
How is a virus going to gain immunity to an antibiotic?
By changing its 30s ribosomal subunit....wait
By altering its cell wall prot- nevermind
By effluxing the antibiotic out of...hold on a minute
They produce metalloproteinases...that...render the uhh. Wait. Viruses aren't living cells and lack every target of every antibiotic in existence by definition.
0
Posted on 9/4/19 at 6:51 pm to WeeWee
quote:
Rheumatic fever is super, super rare in the west.
quote:
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.
Not a bad idea, but probably wrong, based on the epidemiological data.
quote:
Many physicians argue that the reason for the decline in RF and RHD is because we treat every patient with pharyngitis for strep. However, epidemiologic data speaks against this. The incidence of streptococcal diseases fell long before the advent of antibiotics but fell concurrently with improvements in public health. It is a far more likely scenario that improvements in sanitation have led to shifts in the serotype of Group A beta-hemolytic streptococcus that causes strep throat in developed countries.
quote:
I am pretty sure that the rural WV town that one of the outpatient clinics qualifies as third world.
No it doesn't
All the data I've been posting in this thread relates to the United States, of which WV is a part. Just wait 10 years for people to catch on, and prescribing abx for strep throat will be considered old timey medicine in the US (but probably still taught for Step 1). You know how medicine (and especially boards) lags behind the literature. How far are you into your training?
Posted on 9/4/19 at 7:01 pm to Bedhog
I barely made it through a bachelors degree at LSU. I figure the doctor knows more than me.
Posted on 9/4/19 at 8:55 pm to cwil177
quote:
No it doesn't All the data I've been posting in this thread relates to the United States, of which WV is a part. Just wait 10 years for people to catch on, and prescribing abx for strep throat will be considered old timey medicine in the US (but probably still taught for Step 1)
I’m guessing that you are still in residency and not in the real world. You can prescribe abx for strep throat and have the symptoms alleviated within 24 hours, or tell the parents of a 7 year old that they should just wait it out another few days.
The real world is different than a textbook.
Posted on 9/4/19 at 9:30 pm to Ric Flair
Nature Boy gets it
Posted on 9/4/19 at 9:34 pm to Bedhog
They love passing out drugs. It's like giving candy to people on Halloween.
Doctors are legalized drug dealers/pushers
Doctors are legalized drug dealers/pushers
Posted on 9/4/19 at 9:35 pm to Ric Flair
That’s kind of what I was arguing for. I do a wait and see approach with otitis media, for example. And what I’ve been posting here isn’t textbook (outdated) info, it’s current literature. Do you routinely tell patients to stop taking antibiotics if they feel better? Where do you get that from? Legitimately curious. If you have a negative culture then it makes sense. We also probably have different specialties. I get zero follow up with my patients so I don’t get to see how they are doing after 24 hours of treatment.
Posted on 9/4/19 at 9:37 pm to gumbodawg
Evidence based medicine doesn’t mean a thing if I can’t swallow my own spit due to pain from strep pharyngitis.
Posted on 9/4/19 at 9:39 pm to Volt
quote:
The MD knew he didn’t need to test based on this. Look it up everybody and educate yourselves
these are the old guidelines. Since 2012 the IDSA advises testing everyone even if you are empirically treating. Educate yourself
Posted on 9/4/19 at 9:41 pm to Ric Flair
How many years out from residency are you, Ric, and what state do you practice in? I get what you’re saying. That’s where shared decision making with the patient comes in. If it’s that bad though I’m probably treating empirically and also giving 10mg dex. In fact you’re describing my last patient Monday to a T.
Posted on 9/4/19 at 9:42 pm to Bedhog
What is that thing on your wrist that tells time?
Once you answer that question, here is a follow up one.
How do you know?
Once you answer that question, here is a follow up one.
How do you know?
Posted on 9/4/19 at 9:45 pm to Bedhog
quote:
Antibiotics for strep without even running a test. Only visual inspection of ears and throat. I
Sore throat, exudative tonsillitis, fever, and soft palate petechia? Exam more accurate than swab. At best a strep swab is about 70-75% accurate. Very likely to get a false negative on a squirming kid. A culture may take a week to get back, cost more than your visit and delay treatment which can lead to many complications.
But she could've explained this in just a few seconds and let you make the choice. I'm fine either way. But under treatment of strep due to under prescribing of antibiotics and reliance on strep swabs had led to a resurgence of rheumatic fever and rheumatic heart disease. Strep can cause some bad shite if not treated.
Posted on 9/4/19 at 9:50 pm to cwil177
quote:
nd prescribing abx for strep throat will be considered old timey medicine in the U
. And what will you prescribe? GTFO. Posted on 9/4/19 at 10:14 pm to Bedhog
Over prescribing antibiotics is a problem with upper respiratory tract infections that are obviously viral. That is creating unwanted resistance.
Treating strep throat with antibiotics is what antibiotics were made for. I reduces morbidity and mortality. So if the signs and symptoms are classic for strep you treat it. Relying on a culture isnt practicing good medicine.
Sounds like you have a good doctor
Treating strep throat with antibiotics is what antibiotics were made for. I reduces morbidity and mortality. So if the signs and symptoms are classic for strep you treat it. Relying on a culture isnt practicing good medicine.
Sounds like you have a good doctor
Posted on 9/4/19 at 10:14 pm to SmackoverHawg
I’m just saying there is a compelling argument to be made for just letting it ride its course, since suppurative complications of strep seem unaffected by treatment and given that for every million patients treated you get about 24,000 cases of anaphylaxis, there is a tenuous risk/benefit at play. If symptoms are bad enough you treat every time and await the culture. Even if that rapid strep is negative if it looks bad enough and lacks viral features I would treat.
Posted on 9/4/19 at 10:31 pm to cwil177
quote:
for every million patients treated you get about 24,000 cases of anaphylaxis,
I'd like to see the data on this. What are you calling anaphylaxis and what are the end points?
Posted on 9/4/19 at 10:48 pm to cwil177
treating strep throat with antibiotics will be considered old timey medicine in the future? that gets an lolz from me.
Posted on 9/5/19 at 6:00 am to Bedhog
Strep is easily identifiable by the smell coming out one’s mouth. This with the fact ole Doc probably seen 40 people this week with strep it’s easy to identify without a test when it’s going around.
Posted on 9/5/19 at 6:16 am to cwil177
Just let strep ride? Hell, no.
Page 6 of 6
Popular
Back to top
Follow TigerDroppings for LSU Football News