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December 2003

Questioning DogmaIs This Test Needed?

Arch Pediatr Adolesc Med. 2003;157(12):1157-1158. doi:10.1001/archpedi.157.12.1157

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?

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