Oseltamivir Won’t Keep You Out of the Hospital
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This systematic review and meta-analysis concluded, with moderate certainty evidence, that oseltamivir has little to no effect on hospitalization but does increase nausea and vomiting.
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Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients With Influenza. JAMA Intern Med. 2024 Jan 1;184(1):18-27. doi: 10.1001/jamainternmed.2023.0699. Erratum in: JAMA Intern Med. 2023 Nov 20;: PMID: 37306992; PMCID: PMC10262060.
How to Treat Infected Kidney Stones
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All patients with infected ureteral stones necessitate a urine culture, antibiotics, and urology consultation in the ED, with the majority requiring admission for surgical intervention. Very few, in consultation with urology, who have small, non-obstructing stones and are otherwise young healthy individuals can be discharged with oral antibiotics and close follow up.
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High risk and low prevalence diseases: Infected urolithiasis. Am J Emerg Med. 2024 Jan;75:137-142. doi: 10.1016/j.ajem.2023.10.049. Epub 2023 Nov 3.
Does SARS-CoV-2 Lead to Misstep-by-Steps in Febrile Infants?
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In febrile infants with SARS-CoV-2 infection, current risk stratification tools for identifying invasive bacterial infections (IBIs) demonstrate high negative predictive values at the cost of decreased sensitivity.
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Inflammatory Markers in Febrile Young Infants With and Without SARS-CoV-2 Infections. Pediatrics. 2024;153(2):e2023063857. doi:10.1542/peds.2023-063857
Does This Febrile Neonate Need a CXR?
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This prospective study identified a handful of clinical features associated with radiographic pneumonia in young febrile infants, including elevated procalcitonin and/or absolute neutrophil count, respiratory distress, and positive viral testing.
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Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study. Emerg Med J. 2023;41(1):13-19. Published 2023 Dec 22. doi:10.1136/emermed-2023-213089.
Pediatric Gastroenteritis – 22 Pathogen Stool PCR for All?
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This prospective multi-center stepped wedge trial found that routine molecular multiplex testing for all children who presented to pediatric EDs with acute gastroenteritis detected more clinically relevant pathogens (2.1% to 15%) and led to an adjusted 21% decrease in return visits.
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Clinical Impact of Multiplex Molecular Diagnostic Testing in Children With Acute Gastroenteritis Presenting to an Emergency Department: A Multicenter Prospective Study. Preprint. medRxiv. 2023;2023.07.27.23293208. Published 2023 Jul 31. doi:10.1101/2023.07.27.23293208
CAP Coverage – Beta Lactam Only?
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In patients hospitalized with non-severe community-acquired pneumonia (CAP), beta-lactam (BL) only antibiotic regimens have been shown to have increased mortality as compared to other first-line regimens.
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Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study. Chest. 2024 Jan;165(1):68-78. doi: 10.1016/j.chest.2023.08.008. Epub 2023 Aug 11.
New Meta-Analysis – Steroids Lower CAP Mortality
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This meta-analysis found a reduction in all-cause mortality in patients hospitalized with severe CAP who received adjunctive corticosteroid therapy.
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Efficacy and Safety of Corticosteroid Therapy for Community-Acquired Pneumonia: A Meta-Analysis and Meta-Regression of Randomized, Controlled Trials. Clin Infect Dis. 2023 Dec 15;77(12):1704-1713. doi: 10.1093/cid/ciad496.
Do Febrile Neonates with COVID-19 Need a Full Workup?
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This systematic review and meta-analysis of almost 4,000 febrile infants ≤ 90 days old diagnosed with COVID-19 indicated that these patients have a low prevalence of invasive bacterial infection (IBI), especially the subgroup >28 days old.
Can We Seriously Consider Non-op Management of Appendicitis?
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This expert opinion piece recommends consideration of nonoperative antibiotic treatment for select cases of uncomplicated acute appendicitis.
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Treatment of Acute Uncomplicated Appendicitis. Treatment of Acute Uncomplicated Appendicitis. N Engl J Med. 2021 Sep 16;385(12):1116-1123. doi: 10.1056/NEJMcp2107675.
Direct Oral Challenge – Bye-Bye Penicillin Allergy!
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While removing low risk amoxicillin allergies in the pediatric ED setting by direct oral challenge (DOC) may be effective, numerous factors play a role in reliable implementation.
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Multisite Oral Amoxicillin Challenges During Pediatric Emergency Department Visits. JAMA Pediatr. 2023 Oct 2:e233659. doi: 10.1001/jamapediatrics.2023.3659. Online ahead of print.