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No Antibiotics for You!

Andy Little, DO, Drew Kalnow, DO, and Mizuho Morrison, DO
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17:29
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No me gusta!

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Being pressured to provide antibiotics when its not indicated is a common phenomenon. Miz chats with EM-Over-Easy guys Andy Little and Drew Kalnow on ways to approach this ask, and ways to educate our patients in a constructive way. 

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J.A. W. -

What topical otic solution are you referring to for otitis media at minute 13:09? I heard that there used to be a topical otic solution for pain, but I thought it was removed from the market due to adverse effects.
Thank you!

Ian L., Dr -

In ID killers Urgent Care Rap Delaney and Pescatore talk about the new found. Fido bacterium Necrophorum which responds to Penicillin and presents Penicillin VK 500mg BD and presents with fever exudative pharyngitis and reactive cervical adenopathy .
Missing it can lead to Lemierre's Syndrome and peritonsiller Abscess .
The foreword is that pharyngitis is now surprisingly complex ! June 2019 UC Rap
The hacking cough going on for days with a fever and phlegm is the bug bear of avoiding the Azithromycin 3day pack - it could be Bordetella Pertussis !
In fact if there has been a Bordetella outbreak that cough in adults deserves Azithromycin .
Symptomatic treatment for hacking cough is not so efficacious codeine cough mixtures are now frowned upon but honey in many over two years old in formats some contend helps with paracetamol .
Always useful to check for reactive airways or croup because then oral corticosteroids can dramatically help .
Moderately Severe Sinusititis also respond to systemic corticosteroids in my experience .
Many would prescibe antibiotic Amoxycillin (if not allergic or past history adverse events ) for an 18 month old with fever crying and and a bulging red eardrum .
Hoberman A in N ENG JM Dec 2016 found 10 days of treatment with Amoxycillin -Clavulanate had less clinical failure 16% than those treated for five days 34%?.
Authors did get grants from Pharmaceutical Organisations .

Mike W., MD -

Thx for the comments and insight Ian!
M

Douglas F. -

regarding ear infections, the data is clear that symptomatic management for 2 days make sense but for my patient population asking a parent to take time off for repeat visit in 48 hours to have the ear re-checked is often not realistic. My general practice due to this is delayed abx with the parents advised to start the abx in 48 hours if the pain/fever is not improving with NSAIDs.

Mike W., MD -

There are certainly a lot of options and an ATB script is used by many. It it interesting to me to compare ATB to placebo when they should be compared in studies to standard treatment, which you advocate, which is symptomatic treatment likely with combo acet and ibu. Thx for the comments!
M

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Hippo Urgent Care RAP - December 2019 Written Summary 273 KB - PDF

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