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Antibiotics have not been shown to impact post-strep GN.  The only reason to
treat is to reduce the rate of rheumatic heart disease, which in this age
range, for all intensive purposes, does not occur.  Mike Falk

Sent from my iPhone

On 2010-05-29, at 7:09 PM, Fergus Thornton <[log in to unmask]> wrote:

You talk about treating the disease; are you equating a + strep with the
disease?
#2 is less than 24 hours; not worth a course of Ab's
#3 the latest I've read is that there is no relationship.
#4 What's the incidence of PSGN in this age group?
#5 doesn't occur in this age group
Nope, haven't convinced me yet to test or treat these kids with Ab's.

-----Original Message-----
From: Kevin Powell <[log in to unmask]>
Sent: May 29, 2010 1:26 PM
To: [log in to unmask]
Subject: Re: Rapid Strep Test < 2 years old

I treat strep infections
1.. to reduce contagion
2.. to speed healing and reduce suffering
3.. to reduce suppurative sequelae
4.. to reduce other sequelae, such as glomerulonephritis
5.. to prevent rheumatic fever
roughly in that order.

I think the 1990 era teaching that treatment didn't reduce length of illness
was supplanted by 2000 with data showing 1 day fewer of symptoms by treating
typical strep pharyngitis in older children. No data in the toddlers. There
are lots of places in ER medicine where I would like to reduce exposing kids
to antibiotics. Disease with a proven bacterial pathogen is way down the
list.

{SIDEBAR: Eliminating antibiotics for wheezing toddlers with minimal CXR
findings would be high on my list. This past year I've been working as a
hospitalist for pulmonology and I am frustrated with the number of consults
weekly that involve telling parents their child with recurrent pneumonias
doesn't have an immunodeficiency, he has undertreated asthma.}

The risk/benefit of testing will be different in toddlers.  As I said
before, I don't routinely test for strep in toddlers with sore throats - far
too many viral illnesses. But if a sib has strep or other factors raise the
concern, it is appropriate to test toddlers and, unless shown an applicable
Bayesian analysis, I would recommend treating the disease when it is found.

If an institution has a protocol in place to do rapid streps in triage on
all children with fevers or sore throats, I have minimal experience
practicing that way and defer to others to cite references on that protocol
applied to toddlers.

Kevin Powell MD PhD FAAP
SSM Cardinal Glennon Children's Medical Center
Associate Professor of Pediatrics
Saint Louis University

-----Original Message-----
From: Chamberlain, Jim [mailto:[log in to unmask]]
Sent: Saturday, May 29, 2010 8:52 AM
To: Kevin Powell; [log in to unmask]
Subject: Re: Rapid Strep Test < 2 years old


But the reason we treat Strep is to prevent rheumatic fever. Children this
age don't get RF. Data on symptom resolution suggests a minimally faster
improvement if treated. So why expose all these kids to antibiotics?


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Fergus Thornton
read my blog @ http://docdownunder.wordpress.com

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