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> Any critique of me
Write in ENGLISH!!!
I lost 3 contact lenses trying to work out what half the stuff you used here insetad of "words". Forgive me for so severly demoting that literary entity by using it even in comparison with abominations such as "b9" and "+nit" and "mssa"...
Not to worry - only kidding. Managed to work them all out and had a good laugh along the way...
But forgive me, please, if I have misunderstood what you say after all...
Patient seems to have a UTI... But is active and playing (although with a raised temperature)
Urine growing Staph which is sensitive to Methicillin...
Patient has had 24 hours' worth of amoxicillin...
And you change it at that point to BOTH rocephin AND keflex.
Now these are lovely antibiotics and all that, but I am curious as to what sort of urine culture result would have made you give the amoxicillin & fever the chance to work? Seems to me that if finding that a patient who is on amoxicillin DOES indeed have a sensitive organism still does not convince us to let that antibiotic have a "go", then amoxil should be declared as something which people should NOT be giving out to patients with UTI at all. I would be quite happy to have this put on paper - "do not use amoxicillin for UTI" - as I do not think it has a good enough chance to be used empirically with resistance levels as they are, but in this case we SEEM to have got lucky...
> I saw one of these yesterday. 3 yo with fever for 4 days. only complaint was mild abd pain. seen 3d b4 and other doc got cbc, chem 7, and urine. exam was b9. wbc=24k. urine with +trace nitrate and 4 wbc/hpf. sent home with no abx. came back the day b4 i saw her, and repeated wbc=12 and got strep screen altho throat exam said normal and it was + (although also + in oct). started on amox. came back yesterday and i saw her. extremely adorable and pleasant and playful active who"kept mom up all not" treating the fever. the temp was 102.9. all ohter vitals normal. urine now groing staph aureus 25-50k that is mssa. was a cath spec. repeat urine with 4wbc and +nit. I switched to keflex and gave shot of rocephin.
Any critique of me (or others- i would critique others).
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