Thank you Paulus for your comments.I was thinking ...

2007-12-23T18:06:00.000-08:00

Thank you Paulus for your comments.

I was thinking of meningitis. And FBE would ideally have been done but was not done in this case.

Although we all know that antibiotics should not be pescribed for ALL fever, it is rarely done in practice, especially private practice. There are other factors that influence how we pescribe.

I think by putting up this blog, I also want to bring into discussion the role of private medical care in developing countries.

Any comments?

Rodney,From a Paediatrician's perspective I would ...

2007-12-07T23:30:00.000-08:00

Rodney,

From a Paediatrician's perspective I would think the management is reasonable though I would question why the use of ceftriaxone.

I guess you want to exclude meningitis and though clinically a 3 year old boy should manifest signs of meningeal irritation one can never be sure if there is prior use of antibiotics.

If so the use of ceftriaxone could still mask clinical signs and one would need to be sure that meningitis is excluded; most easily in your situation by doing an FBE (I dont think an LP is warranted) before discharge.

It is always hard when you are seeing patients who are already on antibiotics (which in PNG we throw around too frequently).

The general use of ceftiaxone for conditions other than meningitis is unfortunately widespread and needs to be regulated.

In children under the age of 2 we generally use ceftriaxone until we know sensitivities of the organism if we isolate. This is because over half the H Influenzae in PMGH are resistant to chloramphenicol.

However pneumococal meningitis predominates from second year of life onwards and is still sensitive to CMP.

Paulus

Comments on General Practice In PNG: How would you have managed this case?

Thank you Paulus for your comments.I was thinking ...

Rodney,From a Paediatrician's perspective I would ...