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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?
>
>
>For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html


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

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html