In message <[log in to unmask]>, Paul Caldwell
<[log in to unmask]> writes
>I always take a T/S before (v v rarely) giving abs for sore throat or
>tonsillitis.
Sore throat or visibly inflammed tonsils? If the symptoms have been
present for >48 hours and there's nothing much to see, I wouldn't give
them either.. on the othr hand, if there is exhudative tonsillitis , I
might very well.
I only do investigations if it will influence my management.. there
doesn't seem much point if I'm going to give an antibiotic anyway!
>Interstingly v few grow anything-good clincial audit .
uh?
> I did a
>prospective audit of 100 sore throats and 35 acute follicular tonsillitis,
much better
>only 10% of sore htroats and only 35% of tonsillitis grew path streps.
how virulent is the streptococcus these days?
when I was at Bellvue New York ( more years ago than I care to
remember..) rheumatic heart disease was probably the major diagnosis in
the cardiology clinic. I have a number of patients with probable
rheumatic heart disease - but no kids or youngsters. Is this due to to
the known decreasing virulence, or to the "overuse" of antibiotics
removing the organism before it can cause complications? Come to that,
*does* elimination of a streptococus early prevent secondary
complications? Any sound studies? We used to put everyone with rheumatic
fever and carditis on pen V until 18 (I think - very long time ago!) to
prevent a second attack..
> Sputum
>c+s i find useless unless a chest physio makes the pt cough.
I'd normally treat chest infections without a culture - tend to agree -
if a sputum culture is needed, don't they need a referal?
> Only do MSUs in
>doubtful cases or in males. I find nitrite/leucocyte stix v useful in the
>surgery.
I think there is a valid point here.
1. how much antibiotic resistance is there in the community?
I try to watch the resistance profile - but don't believe in "new"
antibiotics without cultures..
2. would the fact that the cystitis was due to infection alter future
management? i.e. do you need to document an infection - whether or not
it afects your immediate treatment?
> Only do HVS for candida if symps recurs quickly
Hmm. I suggest a thrush treatment and offer swabs if it doesn't work..
> or if green or yellow
>discharge.
sorry, is this significant diagnostically?
> Only do viral swabs for genital ulcers.
I refer to special clinic - they've got better facilitis!
Mary
PS how far are you from the lab and GUM clinic? obviously makes a
difference!
>----------
>From: [log in to unmask] on behalf of Katie Law
>Sent: 17 June 1998 18:46
>To: [log in to unmask]
>Subject: Swabs before antibiotics
>
>Is there a consensus on whether and when one takes swabs before
>treatment with antibiotics?
>
>KT
Mary Hawking Kingsbury Court Surgery Church Street Dunstable LU5 4RS
tel:01582 663218 (surgery)fax:01582 476488 (surgery)
Member of British Healthcare Internet Association
Dunstable and Houghton Regis Locality Commisssioning Pilot
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