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I realize I wrote this poorly and it is confusing.  But I am advocating
only treating patients with rapid strep or culture proven GABHS with abx
and not treating all comers with sore throats. After reading it, I
realized that that did not come across.
 
 
> Hop-count: 10
>
> I am not sure of the value of the previous cost-benefit analysis by Dr.
> Newdow.
>
> If we assume that all ARF is caused by GABHS and that the bacteria is
> 100% sensitive to antibiotics, then the population attributable risk of "not
> treating with ABX" is 100%.
>
> Since the sensitivity and specifity of combined Rapid strep and culture
> is quite high, and the prevalence of the disease among the select
> population (children greater than 5 with sorethroats) is also high, then the
> positive predictive value should be high. Very few cases will be missed and
> less needless abx will be prescribed which is of clear benefit to the public.
> My understanding is that the 1-2 day delay in treatment while waiting for
> the culture does not increase the risk of ARF.
>
> I can think of no argument to justify treating everyone, unless your
> department refuses to do rapid streps and cannot do follow-up on patients
> for socioeconmic reasions.
>
> 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://www.brown.edu/Administration/Emergency_Medicine/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://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html