Centor Criteria: Antibiotics or Not?

 

The Centor score is an appropriate screening method for acute tonsillitis but limited to patients of at least 15 years of age. The Centor score uses 4 signs and symptoms and a scale of 0 to 4 for diagnosis.

  1. history of fever > 38oC,
  2. absence of a cough,
  3. swollen and tender anterior cervical lymph nodes, and
  4. tonsillar exudates or swelling

Both the sensitivity and specificity of this prediction rule are 75%, compared with throat cultures. Antibiotics are advised if the Centor score is 3 or above.

 

Chest Pain in Atrial Fibrillation

This is a great example of how the dichotomy between STEMI and Non-STEMI is false.  They are both due to thrombus in the coronary artery and both are very dangerous.  STEMI and NonSTEMI exist on a spectrum.  Thrombus can lyse and propagate, and NonSTEMI can convert to STEMI.

 

UTI Myths and Misconceptions

  • UTI is a clinical diagnosis, not a laboratory one. Dysuria plus urinary frequency in the absence of symptoms of STI is diagnostic.
  • Most patients with a clinical picture consistent with a lower UTI do not require urine tests.
  • The indications for urine tests for suspected lower UTI include immunocompromised patients, history of multiple courses of antimicrobial therapy, history of antibiotic resistance and history of multiple drug allergies.
  • While bacteria seen on microscopy is predictive of a positive culture, it is not necessarily diagnostic of a UTI as the positive culture could represent a contaminant or asymptomatic bacteriuria.
  • A common pitfall is treating non-pregnant patients with asymptomatic bacteriuria with antibiotics. Asymptomatic bacteriuria is very common in all age groups and is often misdiagnosed as a UTI.
  • Do not routinely treat catheterized patients found to have pyuria or candida in their urine.
  • A common pitfall is to assume that the cause of altered level of awareness in an elderly is a UTI upon finding pyuria or bacteriuria on urinalysis leading to premature closure and missing a more serious diagnosis.
  • Imaging is not routinely required for patients suspected clinically of pyelonephritis.
  • Cranberry juice, direction of wiping and voiding post intercourse are not effective in preventing recurrent UTIs
  • 3-5 days duration of therapy is sufficient for the vast majority of lower UTI

 

What’s the “Best” Site for Central Line Placement?

Using the subclavian site for central venous catheterization reduced infections and DVT to a minimum, but tripled the risk of pneumothorax compared to the internal jugular (IJ) position. Using the femoral position eliminated pneumothorax risk, and was comparable to the IJ in infection risk, but significantly increased DVT risk.