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Old 09-20-2015, 13:43   #31
NurseTim
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Quote:
Originally Posted by PedOncoDoc View Post
Not to hijack this thread, but how do you separate the effects of antibiotic exposure from those of hormone exposure from the food supply?
As well as hormones from our water supply, waste treatment doesn't remove the hormones in the water from women on the pill, and various other hormone therapy.
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Old 09-23-2015, 10:30   #32
frostfire
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Hmmmm, you mean amoxicillin for ear infection is containdicated in regards to abx resistance? How about for strep throat?

Yes, in triage most parent told me the child has fever just few hours or that morning prior to their bringing them to the ER. It doesn't help either when they bring all 5 kids for sniffles and then complain of long wait time.

In my prior job, parents would explode at the PA after they waited 4 hours+ and not get antibiotics for their children's URI

Quote:
Originally Posted by PedOncoDoc View Post
Regarding ear infections - there is a lot of evidence from Europe that many ear infections will resolve on their own if you wait 48-72 hours after the diagnosis of an ear infection. It is common practice in many areas to give a "provisional" prescription with orders only to fill the prescription if the fever and/or ear pain persists beyond the 2-3 day window after the appointment.

The reason we treat ear infections is twofold: 1) on occasion they can erode into the skull and cause more severe/life threatening infections, and 2) Recurrent/chronic ear infections can lead to permanent hearing loss.

Regarding the notion of taking kids to the doc every time they sniffle - that would take a culture change. At least your wife is seeing their primary care provided and not misusing the emergency department.

General rule of thumb: If fevers last less than 5 days, the kid is alert/arousable and eating/drinking, doesn't have a severe headache/stiff neck, and doesn't have difficuly breathing, it can probably wait until one of these criteria isn't met.


This is spot on. Return visit to the ER (never mind the pt fails to follow up with PCM) is avoided like a plague


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Originally Posted by Trapper John View Post
One afterthought to your question xSF Med - the answer to your question may lie in economics and not medicine. Current healthcare economics demand less hospital time. The thinking, therefor, may be "I will give this ID patient the big gun and get him/her out sooner thus reducing the hospital time and therefore the cost."

Short term thinking. Second and third order effects are the patient needs to be re-admitted and now may have a drug resistant infection. Payers refusal to pay for re-admissions may turn that logic around though.

I can see a similar rationale playing out in outpatient clinics as well.

Just a thought.
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Last edited by frostfire; 09-23-2015 at 10:35.
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Old 09-23-2015, 18:24   #33
cold1
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Quote:
Originally Posted by PedOncoDoc View Post
Regarding ear infections - there is a lot of evidence from Europe that many ear infections will resolve on their own if you wait 48-72 hours after the diagnosis of an ear infection. It is common practice in many areas to give a "provisional" prescription with orders only to fill the prescription if the fever and/or ear pain persists beyond the 2-3 day window after the appointment.

I have heard of this also but the main reason that parents seek Antibiotics is because the kid is in pain. Again, talking to my parents they said that the Drs. would puncture the ear drum and let the infection drain. This alleviated the pain and help clear the infection up. I understand why this couldnt be done on chronic infections, but if the kid only gets 1-2 a year what harm would be done in going back to this method?

The reason we treat ear infections is twofold: 1) on occasion they can erode into the skull and cause more severe/life threatening infections, and 2) Recurrent/chronic ear infections can lead to permanent hearing loss.

Regarding the notion of taking kids to the doc every time they sniffle - that would take a culture change. At least your wife is seeing their primary care provided and not misusing the emergency department.
With the rise of urgent care facilities, the need to go to the ER is almost nonexistent for us. Before Urgent care, if we had a problem after 5pm, there was no other option but the ER.

General rule of thumb: If fevers last less than 5 days, the kid is alert/arousable and eating/drinking, doesn't have a severe headache/stiff neck, and doesn't have difficuly breathing, it can probably wait until one of these criteria isn't met.
It doesnt help when I talk my wife into waiting a few days to go to the Drs. only to have the Med Professional admonish her for not bringing them in sooner.
Bolded is mine

Thank you Doc for addressing my post.
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