Tuesday, March 14, 2017

Oral Versus Intravenous Antibiotics: Do the Bugs Know (or Care)?

What's so magical about the route of antibiotic administration? I can understand how lay persons may perceive parenteral antibiotics as "stronger," but sometimes I think medical personnel fall victim to the same misconception. Here's a study that suggests step-down to oral therapy is a better plan for children with pneumonia complicated by pleural effusion, although I think the authors' conclusions require evidence beyond just this one study's results.

Source: Shah SS, Srivastava R, Wu S, et al. Intravenous versus oral antibiotics
for postdischarge treatment of complicated pneumonia. Pediatrics. 2016;138(6):e20161692; doi:10.1542/peds.2016-1692. See AAP Grand Rounds commentary by Dr. Daniel Lesser (subscription required).

Tuesday, March 7, 2017

Acute Otitis Media Treatment Duration: Is There a Reason We Have Ten Fingers?

This study, comparing 10 days versus 5 days of antibiotic treatment for acute otitis media (AOM), resulted in some surprising conclusions and a host of study design topics for discussion. Read on.

Source: Hoberman A, Paradise JL, Rockette HE, et al. Shortened antimicrobial treatment for acute otitis media in young children. N Engl J Med. 2016;375(25):2446-2456; doi:10.1056/NEJMoa1606043. See AAP Grand Rounds commentary by Dr. Rebecca Brady (subscription required).

Wednesday, March 1, 2017

March in Evidence Land

Hello everyone, and welcome to yet another month of AAP Grand Rounds articles and further commentary in Evidence eMended. In this month's edition of AAP Grand Rounds, look for discussions of variations in management of young febrile infants, more data on hazards of those yummy-looking laundry detergent pods, new treatment for supraventricular tachycardia, and depression in young children, among others.

Every Tuesday this month I'll cover 1 of 4 topics: treatment duration for ear infections, issues in migraine therapy, stepdown therapy for complicated pneumonia, and acute kidney injury in critically ill children.

Tuesday, February 28, 2017

What's a Normal Number of Snotty Nose Episodes in Young Children?

I wish I had a definitive answer to this question, I suspect pediatricians would be forever grateful. This current prospective cohort study tries to address this, but as usual raises more questions than answers.

Source: Toivonen L, Karppinen S, Schuez-Havupalo L, et al. Burden of Recurrent Respiratory Tract Infections in Children: A Prospective Cohort Study. Pediatr Infect Dis J. 2016;35(12):e362-e369; doi:10.1097/INF.0000000000001304. See AAP Grand Rounds commentary by Dr. Daniel Lesser (subscription required).

Tuesday, February 21, 2017

Kawasaki Disease and Steroid Therapy: Not All Meta-Analyses are Created Equally

Kawasaki Disease (KD) has been the bane of my clinical practice for decades: an illness that mimics many others with no definitive diagnostic test, with the majority of cases self-resolving without sequelae but a few with devastating consequences. On the other hand, KD has been a boon for teaching of evidence-based medicine, with the current article a great example.

Source: Chen S, Dong Y, Kiuchi MG, et al. Coronary artery complication in Kawasaki Disease and the importance of early intervention . JAMA Pediatr. 2016; 170(12):1156-1163; doi:10.1001/jamapediatrics.2016.2055. See AAP Grand Rounds commentary by Dr. David Spar (subscription required).

Tuesday, February 14, 2017

Stimulant Meds for ADHD: What are the Risks for Bone Disease?

This well-done retrospective cross-sectional study delivers just what we want from such a study design: a clear path forward to develop a prospective trial to answer a specific question.

Source: Feuer AJ, Rhai A, Demmer RT, et al. Association of stimulant medication use
with bone mass in children and adolescents with attention-deficit/hyperactivity disorder. JAMA Pediatr. 2016;170(12):e162804; doi:10.1001/jamapediatrics.2016.2804. See AAP Grand Rounds commentary by Dr. Daniel Doherty (subscription required).

Tuesday, February 7, 2017

Cardiac Disease Screening in Down Syndrome: Is the Fox Guarding the Henhouse?

Guidelines can be biased, particularly if the guideline developers stand to gain from some of the recommendations. In most cases this isn't an intentional bias, but rather implicit bias hovering beneath the clinician's consciousness. Is implicit bias influencing screening for heart disease in Down Syndrome children?

Source: Bogarapu S, Pinto NM, Etheridge SP, et al. Screening for congenital heart disease in infants with Down Syndrome: is universal echocardiography necessary? Pediatr Cardiol. 2016;37(7):1222-1227; doi:10.1007/s00246-016-1419-2. See AAP Grand Rounds commentary by Dr. David Spar (subscription required).

Wednesday, February 1, 2017

Welcome to February at Evidence eMended

After a tumultuous January, I'm ready to settle back into a more ordinary routine, and February's list of articles in AAP Grand Rounds is a welcome sight. For those of you prudent enough to have subscriptions, you can see reviews of articles on late-onset group B streptococcal disease, maternal flu vaccination, scoliosis surgery in adolescents, and other topics.

This month for my weekly Tuesday postings I'll be expanding commentary on screening for cardiac disease in Down syndrome infants, bone mass measurement in children receiving stimulants, Kawasaki Disease treatment (a great excuse for me to revisit one of the classic "bad" study designs in medicine!), and more information on the burden of respiratory infections in young children.

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