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I have strep about three times a year since I moved to Atlanta, about once
per year before that.  SEveral times I have been unable to get to be
tested, and I am feverish and miserable and going to sleep at 0830PM until
I get to employee health or the doctor to get the swab.  I don't take amox
unless I know for sure it's strep, but each time this has happened I feel
much better within 12 hours of starting antibiotics and the fever goes
away.  I'm not saying other people get better that fast, although when
I've been camp doctor I see similar resolution of strep with abx but not
strep negative with no abx.  My personal N is about 16.  The longest I've
been uncomfortable and feverish and miserable before getting the swab is
about 4 days.  The shortest time is about 5 hours, when I knew I had an
exposure and started feeling the symptoms.  And, of course, I do wear a
mask when I swab now so it's been about 6 months!  I'm doing well!

How do you feel about treating UTIs in women?  Let them fight the symptoms
and wait it out since pyelo is uncommon?

Thanks for your a priori assessment that I am evidence based!  

Take care,
Amy



William Gibson <[log in to unmask]> writes:
>Dr. Baxter,
>    Thank you for your personal opinion, but what is the evidence to
>support 
>your claim.  No study has shown that people get better in 12 hours if you 
>treat strep with an antibiotic.  I am glad placebo works for you, but I 
>don't think it's a solid foundation for the practice of medicine.  I am 
>surprised that you do.
>
>Wm Gibson MD
>----- Original Message ----- 
>From: "Amy Baxter" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Thursday, June 03, 2010 9:19 AM
>Subject: Re: Strep--Other Considerations
>
>
>> OK, I've stayed out of this, in part because I agreed with Kevin
>Powell's
>> comments and didn't want to be redundant, but seriously?  When I start
>to
>> feel streppy because some kid I did a strep test on coughs in my face, I
>> am thrilled when the swab they do at employee health comes back
>positive.
>> Thanks to the wonders of post-1943 medicine, I know I'll be feeling
>better
>> in 12 hours and don't need to try to swap my shift the next day, know I
>> will be productive again, know I can manage my own contagion.  And of
>> course I take antibiotics!
>>
>> I do lots of pain drops for viral otitis, and am scrupulously
>parsimonious
>> even when parents of adenoviral children wail and get in my face.  I
>swab
>> children less than three years once or twice a year, I quote the red
>book,
>> and even when they have exudates and a positive family contact if the
>> rapid is negative, too bad: no antibiotics for you.  But in the face of
>a
>> positive bacterial contagion, the "high likelihood" of an adverse
>reaction
>> doesn't stop me from gratefully getting treatment myself; bacterial
>> illness is what antibiotics are for.  I fight the good fight against
>> antibiotics for viral illnesses on a daily basis, but good heavens, if I
>> have strep, DELUGE me, and that goes double for the patients who entrust
>> their time, health, comfort, and money in me.
>>
>> Double penicillin latte for me, please.
>>
>> -Amy
>>
>> Fergus Thornton <[log in to unmask]> writes:
>>>"Primum non nocere"
>>>
>>>Giving a course of Ab with a high likelihood of an adverse reaction for
>>><24hr sooner relief
>>>violates this.  Many of you seem to be looking at this from the
>>>perspective of one child (yours!) but multiply this by 10,000/day to get
>>>a sense of the unnecessary antibiotics given in the US daily. This is
>>>difficult to justify.  I'm sorry your kid has one extra day of a sore
>>>throat but really . . . . is it worth deluging the world with more
>>>antibiotics?
>>>
>>>-----Original Message-----
>>>>From: "Chamberlain, Jim" <[log in to unmask]>
>>>>Sent: Jun 1, 2010 10:51 PM
>>>>To: [log in to unmask]
>>>>Subject: Re: Strep--Other Considerations
>>>>
>>>>I agree with you about shortening the course of disease.
>>>>
>>>>I disagree that we should lower ourselves so we are practicing at the
>>>lowest common denominator. We need to educate our parents (and
>>>administrators) about the risks and benefits of medications. Otherwise,
>>>we should just put a large vat of amoxicillin in our waiting rooms and
>>>let parents decide when they want antibiotics.
>>>>
>>>>James Chamberlain, MD
>>>>Division Chief, Emergency Medicine
>>>>Children's National Medical Center
>>>>111 Michigan Avenue, NW
>>>>Washington, DC 20010
>>>>
>>>>202.476.3253 (O)
>>>>202.476.3573 (F)
>>>>202.476.5433 (Emergency Access)
>>>>
>>>>-----Original Message-----
>>>>From: Pediatric Emergency Medicine Discussion List
>>>[mailto:[log in to unmask]] On Behalf Of Dave Smith
>>>>Sent: Tuesday, June 01, 2010 4:29 PM
>>>>To: [log in to unmask]
>>>>Subject: Strep--Other Considerations
>>>>
>>>>I want to play devil's advocate for a moment on another set of
>>>perspectives:
>>>>
>>>>1. What is the impact of not treating in terms of outcomes not
>>>considered by studies?
>>>>
>>>>What I mean by this is that it is all well and good to pound the table
>>>and hold up the studies and say, "Best practice says I don't need to
>>>test/treat your 2 year old son, Mrs. Smith," but then, how often does
>>>Mrs. Smith go to the urgent care down the road where they invariably see
>>>a febrile toddler, order blood, urine and a chest xray, and give
>>>Rocephin? Even if she goes to her PMD the next day and they simply do a
>>>strep and treat (which I think most PMD's would do despite our urgings
>to
>>>the contrary), she's now incurred another visit to another medical
>>>provider, increasing overall costs in the process. In the former
>>>case, the child undergoes a while slew of tests and a treatment we could
>>>have prevented. As I like to say, Evidence-Based Medicine is the
>>>beginning of wisdom, not the entirity of it. We also have to practice
>>>"realistic medicine" ." Over-adherence to dogma may lead to
>>>parents seeking other outlets that end up doing far worse
>>>> than a script for PenVK. Writing that script in some (many?) cases
>>>would thus be better practice than what the child ended up with even
>>>though it may not have been "best practice."
>>>>
>>>>2. We live in a world of Press-Gainey
>>>>
>>>>If your hospital administrators are like ours, they don't really care
>>>about the best-practice guidelines...just the satisfaction scores. When
>>>surveys come back giving the doctor a series of 1's because they doctor
>>>"didn't do anything about my child's strep throat and I had to go to an
>>>urgent care" they want to know what we are doing to improve our scores.
>>>Telling them that strep only gets better a day earlier with treatment
>and
>>>the child wasn't in an age range for rheumatic fever so it didn't matter
>>>isn't something they care about. That's how one ends up with language
>>>added to one's contract tying incentives and penalties to Press-Gainey
>>>performance.
>>>>
>>>>3. What's a day worth to a parent/child?
>>>>
>>>>When your child is sick, would you like him to be better a day
>>>earlier? As a parent of four, I would have to say my answer is yes.
>>>Most parents I see would say yes as well. That extra day could be two
>>>extra days in some cases and we have no way of knowing for sure...it
>>>could also be zero, but few parents would see that as an issue if there
>>>is a good chance the illness could be one or two days shorter. For
>>>parents who are working, sometimes in positions where taking more sick
>>>days could mean not advancing or at the very least, being seen as
>>>unreliable because they are always out with "kid issues," that extra day
>>>might mean a lot. So when we say, "It's not worthwhile because they
>>>only get better a day earlier at best," we are making a value judgement
>>>about the worth of a day of wellness and the value of the parents' time.
>>>>
>>>>As I said, just playing devil's advocate. I tend to agree in principle
>>>with what others have written in this thread. But we must always
>>>remember that there are times when we still may be doing better care,
>>>given the balance of all the issues at hand, when we give a little
>ground
>>>on "best care."
>>>>
>>>>
>>>>Dave Smith, MD
>>>>
>>>>
>>>>
>>>>
>>>>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
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>>>
>>>
>>>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
>>
>>
>>
>> Amy Baxter MD
>> Pediatric Emergency Medicine Associates
>> 404 371-1190
>>
>>
>> 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



Amy Baxter MD
Pediatric Emergency Medicine Associates
404 371-1190


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