Doctors Flunk Pee Pee 101 (Article)

Aside from the common cold and stomach bug, parents should add the term urinary tract infections (UTIs) to their shortlist of worrisome common illness, especially if they have daughters. To effectively treat urinary tract infections, pediatricians need accurate diagnosis and tailored therapy. Unfortunately, this information is often lacking. A recent survey of how healthcare providers diagnose and treat urinary infections in children, published in the journal Pediatrics, found that pediatricians, family doctors, and nurse practitioners treating children frequently do not order the necessary tests needed for accurate diagnosis and treatment. Experts recommend a course of antibiotics to treat a UTI, only after the child’s urine has been analysed and cultured. As it turns out, appropriate laboratory confirmation is only being done in about 50% of the time when various outpatient settings were analyzed. Antibiotics were being prescribed without knowing for sure that a child had a urinary tract infection. Amazing.

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Antibiotics not Surgery for a Sick Appendix (Article)

What could be more quintessential pediatrics than diagnosing a child with an acute appendicitis, admitting the child to the hospital, and preparing the family for a surgical procedure to remove the diseased appendix with an operation? This is the way it has been done during my entire pediatric career and for the past 100 years… until recently when the winds of change are blowing fast and hard. First came the advent of laprascopic, minimally invasive appendectomies, now commonly used in skilled hands to remove a sick appendix. Just a few pokes in the abdomen for lights, cameras, and instruments, and out comes the diseased appendix. Amazing.


If that wasn’t enough, now surgeons are actually treating an acute appendicitis with antibiotics and not surgery. Pediatric surgeons in Charlotte and elsewhere have discovered that some IV and oral antibiotics, during the early for children with uncomplicated non ruptured appendices actually recover faster and have less missed school than those that were treated with the standard appendix removal operation.


While the initial research is promising for the antibiotic approach, pediatric surgeons caution it is not for every child with an acute appendicitis. The child’s sick appendix needs to have not ruptured, be non obstructed, and be not too swollen and sick. If you and your child’s doctors catch things early enough however, the antibiotic approach might be a great option for their care. If your child is unfortunate enough to have an inflamed appendix one day, having a treatment other than surgical removal may be a great option to take care of their problem. Now that’s what I call progress.


If you have a comments about this post, take a moment to write them to my blog, I would love to hear from you. Until next time.


Smo Notes:



Written by Paul Smolen M.D.

Cutting Down Antibiotic Use (Article)



Overuse of antibiotics has been a source of worry for both health care professionals and patients for some time. Antibiotics, such as penicillin, help a child’s body destroy or slow down the growth of disease causing bacteria. When you or your child has an infection, whether through ingestion of contaminated food or an infection of an open wound, an antibiotic can be lifesaving. Have you ever wondered why you cannot buy antibiotics over the counter, without a prescription? The answer to that question is simple. Even if you were smart enough to know which one to buy, this practice would undoubtedly lead to even greater overuse of antibiotics with all of it’s attendant consequences;  gastrointestinal problems, such as diarrhea from C. Diff,  drug to drug interactions in which antibiotics interfere with other treatments, and dangerous antibiotic resistance, such as we are seeing around the globe.


Fortunately, a recent study has demonstrated a simple way to prevent some antibiotic overuse. Previously, patients or parents bought and used antibiotic beyond the date when antibiotic use is to end because they simply overlooked the stop order. With the new intervention, your doctor will not only place an “x” on the stop date but also draw a line through the remainder of the month so that you will follow the doctor’s prescription protocol form. This simple method has had significant reductions in number of days when antibiotic was taken..


By flagging a stop date on a patient’s prescription, doctors have discovered another method of safely reducing antibiotic use.  Longtime followers of my blog will remember articles about the so called “Wait and see” approach to treating ear infections that have previously been shown to significantly reduce antibiotic use in children.  ( When it comes to antibiotics and children, that old saying, “Less is more”, just may be true.  Hopefully, the “ Stop now” approach to writing prescriptions will help keep antibiotic use to a minimum.


Your comments are welcome at  Until next time.


Smo Notes:





Written collaboratively by John Eun and Paul Smolen M.D.