> Would appreciate anyone elses comments on this issue as well.
I do what I usually do - leave it up to the patient (well, actually the
parent(s) or guardian(s) when the patient's only a year or two).
I give a brief synopsis of the situation, letting them know that there
is a small but real chance [I try to give an actual number, depending on
the degree of fever, etc.] that some significant infection will result.
I tell them that some people do nothing but observe, some people get
tests (UA, CBC, CXR, ?cultures) and base the decision on those results,
and that some people just treat everyone (po or IM), recognizing that
there's a 95% (or whatever) chance that the treatment will be
unnecessary. I also say that there are no data (that I'm aware of) that
watching carefully for the next 24-48 hours results in any significant
change in outcome.
Then I let them decide.
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