Incompletes?

[Starflyr]

Advertisement - Members don't see this ad

*Sigh*

Ive been pulled out of my Pedi rotation by my PCP b/c Im sick as all get out. Fever (since Tuesday!?! to 102, still with tylenol/motrin), sore throat, swollen lymph nodes everywhere, yes, folks, its either antibiotic-resistant non-group A Strep (rapid strep negative, awaiting culture) or Mono (which I *thought* I already had?) Also awaiting monospot.

At least she gave me good meds - gargle-able lidocaine and Toradol injectables, plus she replaced the Z-pak that student health gave me (she wasnt open, I went there first) with Keflex (allergic to PCN).

Anyway, so as I sit here waiting for my latest self-administerd Toradol shot to kick in so I can get back to sleep (the pain wakes me up when it wears off, like clockwork, every 7 hours), I was wondering...

I really *REALLY* want to go into pedi - how badly is this going to hurt me? I did the first month outpatient, got a good eval from my preceptor, and I had just started my inpatient month on Monday. Im out until at LEAST tuesday (or whenever the fever goes away, which could be as long as Friday), which means, according to the course coordinator that I will have to take an incomplete.

Has anybody else been in this type of situation?

thanks,
star

 

[doc05]

if you have a PCN allergy, why were you given Keflex? Z-pack is probably a better choice.

 

[Starflyr]

b/c Im not allergic to cephalosporins - the 10-15% cross reactivity is questionable anyways, but I have taken cephalosporins w/o issue before - but the one and only time I took amox - bad jujus.

Star

 

[GO_MEDPEDS]

I wouldn't worry too much about it. There are a variety of reasons that med students are unable to complete a rotation (pregnancy/childbirth, illness, unique opportunities). I would just find out what you need to do to get a completion in the rotation and then do your best when you return- just because you won't get a completion doesn't mean that you can't get an letter of recommendation or some good points on your evaluation.

The important thing is to 1) take care of yourself and 2) protect patients from any additional exposure to disease. I actually had a peritonsillar abscess a few months ago and it really interfered with my schedule (Step II, school-sponsored OSCE, and publishing a paper), but everything worked out in the end!

As for the penicillin-cephalosporin allergy cross-reactivity, the latest Peds ID conference I was at quoted closer to 2% allergy crossover...

🙂

 

[AJM]

Not to nitpick, but the Z-pak is azithromycin, not amoxicillin. Azithromycin is in the macrolide class of antibiotics, which have no cross-reactivity with penicillins. 🙂

 

[Starflyr]

AJM - I dont think anybody ever said that a Z pak is amoxicillin. Trust me, I wouldnt have touched it with a 10 foot pole if it were, since Ive known about my anaphylactic rxn to amox for...um 5 years now.

However, azithromycin is not a terribly good antibiotic to use against presumed (non-group A) streptococcal infections.

Based on symptoms and presumed illnessess - which would be strep throat by itself or mononucleosis in addition to strep throat (a common 2ndary infection with mono), #1 choice would be to use a penicillin (not amox or amp, b/c of the rash that you get if you have mono and take aminopenicillins). Second line is a cephalosporin. After that, take your pick, basically, b/c none of them work very well.

In addition, I was still getting worse after 2.5 days of the azithromycin - lots worse, so I would say its safe to assume it wasnt working overly well.

In any case, Ive now gone 12 hours without HAVING to have a shot of Toradol. there IS a God! Woohoo!

Star