Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got the previous case on COVID-19, MIS-C, and Long COVID in Pediatric Patients: An Update right.
Case Presentation: Pediatric Sinusitis: Complications and Management in the Emergency Department
A 5-year-old girl is brought into the ED by her father for persistent fevers and runny nose over the past 3 days…
- The father tells you he is worried that her fevers recur after 5 to 6 hours, despite oral antipyretics.
- On examination, the girl is playful and interactive. Her tympanic membranes are nonerythematous, but she is noted to have yellow nasal discharge. Her father asks for a prescription for antibiotics, since he had a similar illness last week and that was “the only thing that helped.”
- How should you approach counseling with this father regarding antibiotic use for his child?
Case Conclusion
You spent some time counseling this father on your decision to proceed without antibiotics at this time. You explained that, given the duration of symptoms and her physical examination, her presentation was most consistent with an acute viral URI, so antibiotics would be of no benefit in her care. You told him that unnecessary antibiotics can increase resistance patterns and lead to side effects including vomiting, diarrhea, rash, allergic reactions, and yeast infections.
You advised him that her symptoms will likely peak within the next day or two, but she should then have steady improvement. As a part of your discharge instructions, you advised that she should be re-evaluated if she has persistent, nonimproving symptoms lasting longer than 10 days or if she has sudden worsening of symptoms with increased fever. While he was frustrated that there were no medications that could “fix” her symptoms, he was appreciative that you took the time to explain your rationale with him at bedside.
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Last Updated on October 7, 2024
