Hmmmm, you mean amoxicillin for ear infection is containdicated in regards to abx resistance? How about for strep throat?
Yes, in triage most parent told me the child has fever just few hours or that morning prior to their bringing them to the ER. It doesn't help either when they bring all 5 kids for sniffles and then complain of long wait time.
In my prior job, parents would explode at the PA after they waited 4 hours+ and not get antibiotics for their children's URI
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Originally Posted by PedOncoDoc
Regarding ear infections - there is a lot of evidence from Europe that many ear infections will resolve on their own if you wait 48-72 hours after the diagnosis of an ear infection. It is common practice in many areas to give a "provisional" prescription with orders only to fill the prescription if the fever and/or ear pain persists beyond the 2-3 day window after the appointment.
The reason we treat ear infections is twofold: 1) on occasion they can erode into the skull and cause more severe/life threatening infections, and 2) Recurrent/chronic ear infections can lead to permanent hearing loss.
Regarding the notion of taking kids to the doc every time they sniffle - that would take a culture change. At least your wife is seeing their primary care provided and not misusing the emergency department.
General rule of thumb: If fevers last less than 5 days, the kid is alert/arousable and eating/drinking, doesn't have a severe headache/stiff neck, and doesn't have difficuly breathing, it can probably wait until one of these criteria isn't met.
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This is spot on. Return visit to the ER (never mind the pt fails to follow up with PCM) is avoided like a plague
Quote:
Originally Posted by Trapper John
One afterthought to your question xSF Med - the answer to your question may lie in economics and not medicine. Current healthcare economics demand less hospital time. The thinking, therefor, may be "I will give this ID patient the big gun and get him/her out sooner thus reducing the hospital time and therefore the cost."
Short term thinking. Second and third order effects are the patient needs to be re-admitted and now may have a drug resistant infection. Payers refusal to pay for re-admissions may turn that logic around though.
I can see a similar rationale playing out in outpatient clinics as well.
Just a thought.
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Last edited by frostfire; 09-23-2015 at 10:35.
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