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Questioning Dogma
Is This Test Needed?
Arch Pediatr Adolesc Med. 2003;157:1157-1158.
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THE ARTICLE by Currie et al1 in this issue begins by questioning a common medical practice. The authors show that follow-up urine cultures in hospitalized children with urinary tract infections who do not defervesce within 2 days of antibiotic treatment are of no clinical utility. Of the 364 patients in the study, 80% had follow-up urine cultures and none were positive for organisms. Furthermore, one third of the patients treated were febrile beyond 48 hours of antibiotic initiation, indicating that fever is simply part of the natural course of illness under treatment. Because this study is one of the first to examine this question, it must be repeated in other settings, but it raises several important, more general questions to consider: How much of what we do in medicine is superfluous? What is wrong with doing what is "unnecessary"? How do we stop doing what is unnecessary?
The problem of . . . [Full Text of this Article] OVERUSE: CONTRIBUTING FACTORS
PROBLEMS WITH OVERUSE
THE FUTURE
CONCLUSIONS
M. Denise Dowd, MD, MPH
The Children's Mercy Hospital
2401 Gillham Rd
Kansas City, MO 64108
(e-mail: ddowd@cmh.edu)
Vidya Sharma, MBBS, MPH
Kansas City
RELATED ARTICLE
Follow-up Urine Cultures and Fever in Children With Urinary Tract Infection
Melissa L. Currie, Lindsay Mitz, Carolyn S. Raasch, and Larry A. Greenbaum
Arch Pediatr Adolesc Med. 2003;157(12):1237-1240.
ABSTRACT
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