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Jeff et al-
 
For what it's worth, please allow me to flog this gasping equine a
little more. Forgive me, but I can't help myself. I think the studies by
Carrol et al (Peds 1983), Fleisher et al (J Peds 1993), Harper et al
(Ped Inf Dis J 1993) and Bulloch et al (Acad Emerg Med 1997) strongly
suggest (as well as one can in this business), that parenteral
antibiotics will abort a case of meningitis and perhaps even prevent a
death (from pneumococcal meningitis or occult meningococcemia- see
Dashefsky et al J Peds 1983) for every two or three thousand kids
evaluated and treated in this manner. Whether or not this is 'worth it'
is up to the individual physician or perhaps the ethics professors. The
notion that 'good exams' and 'close followup' can prevent deaths is
refuted by the deaths in the Harper and Dashefsky data, accumulated at
institutions where good exams and close followup are routine. For my
research dollar, there are few other areas of pediatric emergency
medicine that have accumulated this bulk of reasonably good data
suggesting that we have an opportunity to occasionally save a life.
 
Jay Fisher
www.pediatric-emergency.com
 
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