Episode 24: De-Bugging the Approaches to Ear Infections and Strep Throat
In episode 24, we continue the discussion of in-office infectious disease management. We discuss a case of AOM in an 8 year old child including the signs/symptoms important in making the diagnosis, pain control and the utility of antibiotics. We then discuss a case of sore throat in a 17 year old woman including a validated scoring system for diagnosis, pain control, and the utility of antibiotics. We don’t complete all upper respiratory infections but make a mess of those we do discuss.
Show Notes
1) Diagnosis of AOM – does this child have acute otitis media
2) Ibuprofen vs acetaminophen for pain control and fever
In musculoskeletal pain in children for every 10 children treated with ibuprofen instead of acetaminophen
1 more will have “adequate” pain relief
In children with migraine, acetaminophen and ibuprofen produced similar pain relief at all endpoints (6 major endpoints) except ibuprofen treated subjects had a 20% absolute increase in the number of children who were completely pain free at 2 hours
Ibuprofen faster (by 26 minutes) for time to fever clearance and a greater time (39 minutes) without fever in the first 4 hours (39 minutes) compared to acetaminophen. No difference in symptoms of discomfort.
Meta-analysis of ibuprofen versus acetaminophen for pain or fever. In children, single doses of ibuprofen and acetaminophen have similar efficacy for relieving moderate to severe pain, and similar safety as analgesics or antipyretics. Ibuprofen was a more effective antipyretic than acetaminophen at 2, 4, and 6 hours post-treatment.
Arch Pediatr Adolesc Med 2004;158:521-6
3) Compared “love” of parent vs television
4) Antibiotic treatment of AOM – Cochrane Library
5) Scoring system for Strep Throat.
6) Antibiotic treatment of Strep throat – Cochrane Library
7) Meta-analysis of short course antibiotic treatment for Group A Streptococcal tonsillopharyngitis
Pediatr Infect Dis J 2005;24:909–17
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