A 4-year-old girl is in the hospital with pyelonephritis. Urine culture shows 100,000 colonies of Klebsiella oxytoca, which is susceptible to all tested antibiotics. After 36 hours of intravenous antibiotics, the patient's temperature decreases from 39.4 C (103 F) to 37.8 C (100 F). She no longer has flank pain or dysuria and is eating and drinking normally. The patient is prescribed oral antibiotics and prepared for discharge home. The mother has contacted an herbalist who recommends treating the infection with motherwort. The mother says, "I know doctors don't believe in herbalism but I tried it for my skin condition and it worked, so I'm going to use it for my daughter no matter what you say." A literature search shows no adverse associations with motherwort. Which of the following is the most appropriate response?

Question

A 4-year-old girl is in the hospital with pyelonephritis.  Urine culture shows >100,000 colonies of Klebsiella oxytoca, which is susceptible to all tested antibiotics.  After 36 hours of intravenous antibiotics, the patient's temperature decreases from 39.4 C (103 F) to 37.8 C (100 F).  She no longer has flank pain or dysuria and is eating and drinking normally.  The patient is prescribed oral antibiotics and prepared for discharge home.  The mother has contacted an herbalist who recommends treating the infection with motherwort.  The mother says, "I know doctors don't believe in herbalism but I tried it for my skin condition and it worked, so I'm going to use it for my daughter no matter what you say."  A literature search shows no adverse associations with motherwort.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c15f_961c_8f63_d9160e94fdc5_MD0005_00 Complementary and alternative medicine (CAM) involves therapies used in conjunction with or instead of conventional medicine. Examples include acupuncture, chiropractic, hypnosis, massage, herbal remedies, and traditional ethnic practices. These therapies are increasingly popular for patients seeking natural remedies and are often felt to have positive outcomes. However, many CAM therapies are also ineffective, potentially harmful, or not rigorously studied. Open communication with patients about CAM builds rapport and trust and helps the physician understand the perceived benefits. In addition, this allows for identification of potential risks and side effects, including whether the therapy interferes with effective conventional care. CAM should be discouraged if it is dangerous or hinders standard medical management. In this case, the patient's mother has clearly stated her intent to practice CAM therapy. Motherwort is an herb used to ease anxiety, treat cardiovascular conditions (eg, tachycardia, hypertension), and regulate menses. It is avoided in pregnancy due to the risk of miscarriage and it is used with caution in patients taking cardiac medications or sedatives. Motherwort is likely safe in this patient and would not interfere with other medications. If the mother is willing to also administer the oral antibiotic therapy and bring her daughter to a follow-up visit, then the use of motherwort can be tolerated. (Choices A and D) CAM therapy should not replace effective conventional care; this patient requires antibiotics and a follow-up visit regardless of motherwort use. Allowing the mother to administer motherwort after signing a release of liability is dismissive and not in the child's best interest. (Choice B) Child Protective Services and a court order are indicated if CAM therapy is life-threatening. The parents' right to make medical decisions for their children is generally upheld unless withholding conventional therapy puts the patient's life at risk. (Choice C) CAM therapy should not alter evidence-based conventional practice. This child has improved clinically and is ready for hospital discharge with antibiotics regardless of CAM being included in her treatment regimen. Prolonging hospitalization is inappropriate and increases the risk for complications (eg, nosocomial infection). Educational objective: Complementary and alternative medicine involves therapies (eg, herbal remedies, massage) used with or instead of conventional medicine. These therapies may be tolerated if they are not inherently harmful and do not interfere with effective conventional care. References: Hospitals and complementary and alternative medicine: managing responsibilities, risk, and potential liability. (http://www.ncbi.nlm.nih.gov/pubmed/22045863) Informed consent: advising patients and parents about complementary and alternative medicine therapies. (http://www.ncbi.nlm.nih.gov/pubmed/22045862) Pediatric integrative medicine. (http://www.ncbi.nlm.nih.gov/pubmed/28847978)

A 4-Year-Old Girl Is in the Hospital with Pyelonephritis