Help Me. I Can’t Speak.

The Hospitalist. 2006 January;2006(01):

January 1, 2006 | The Hospitalist

Meta-analysis showed that short course cephalosporin treatment was superior for bacterial cure rate compared with 10 days of penicillin (OR 1.47; 95% CI, 1.06-2.03). Short-course penicillin therapy was inferior in achieving bacterial cure versus 10 days of penicillin. Clinical cure rate mirrored the bacterial cure rate results. Small sample size limited the statistical power and conclusions of the short course macrolide trials as well as trials of four or five days of cephalosporin therapy compared with 10 days of the same.

This meta-analysis shows that short-course treatment of GAS tonsillopharyngitis can be more effective when prescribing four or five days of cefdinir, cefpodoxime, or cefuroxime treatment than standard 10-day treatment of penicillin. In the United States cefdinir, cefpodoxime, and azithromycin are indicated for short-course treatment. As prescribing practitioners, it is important for us to consider the advantages of shortened antibiotic courses, including improved patient compliance, fewer adverse effects, and reduced impact on development of antibiotic resistance and nasopharyngeal colonization with resistant bacteria. However, the authors emphasize that caution must be used in interpretation of the results of this meta-analysis.

For example, the trials were grouped according to class of antibiotics so that the cephalosporin group included seven different cephalosporins (one first generation, two second generation, and four third generation). In addition, there was much variability in the quality and design of compared studies, which makes it difficult to make strong conclusions. Repeat studies are needed, especially in regard to short-course macrolide or amoxicillin treatment.

What is very helpful is camaraderie with other people who are doing the same work. We cry together, laugh together, and we talk about really awful things in a really coarse way in order to blow off steam, [and] other people looking on might not understand. But that camaraderie is invaluable.

—Georgia Berrenberg, Esq.

The Emotional Toll

Emotions run high when dealing with abused children. The key is remembering why you’re doing the job. “The hospitalist has the opportunity, sometimes, to be the one person to make a difference,” says Dr. Stucky.

“It’s very hard,” says Berrenberg. “I would ... discipline myself to look at it as evidence and to look at in a very cold way, but that only goes so far. A lot of what is very helpful is camaraderie with other people who are doing the same work. We cry together, laugh together, and we talk about really awful things in a really coarse way in order to blow off steam, [and] other people looking on might not understand. But that camaraderie is invaluable.

“Every once in a while, you make a difference, a little bit of a difference and that keeps you going,” she says. “But frequently it feels like spitting in the ocean, too.

“There’s a girl who I met in 1987. I wound up taking her case to court twice because there was a reversal. I see her on occasion. I’ve seen her grow up from a very angry teenager to a pretty OK young woman. I’ve been able to be her friend, and that’s been a big reward for me.”—KL