Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-07-19 Encounter: Spruce text message CC: Charlie tested positive for strep throat at urgent care while traveling in Montana, with ongoing sore throat symptoms and concern about response to antibiotics. HPI: Charlie, a 7-year-old male, developed a sore throat beginning Friday night (approximately 2026-07-18) while the family was traveling in Montana. He was evaluated at an urgent care on Sunday (2026-07-20) and tested positive for strep throat; amoxicillin was prescribed. By Tuesday (2026-07-21), he had not significantly improved after approximately 48 hours on antibiotics — he was waking at night with pain, requiring around-the-clock Tylenol and Motrin, and had developed nasal congestion. A steroid was subsequently obtained by a family member (Dave). He had been in close contact with siblings and cousins since symptom onset. Assessment: Dr. Hobbs noted that the lack of significant improvement after 48 hours of amoxicillin, combined with nasal congestion, raised the possibility of a false-positive strep test and a viral upper respiratory illness. The steroid prescribed by Dave was acknowledged and reviewed; Dr. Hobbs noted no major downside to its use. Plan: Parent counseled that 12 hours after starting antibiotics Charlie would be much less contagious; siblings and cousins should be monitored for symptoms. Dr. Hobbs advised that lack of improvement at 48 hours suggests possible viral etiology. Steroid (obtained separately by Dave/family member) was reviewed and Dr. Hobbs approved holding it to observe daytime progress or giving it; ultimately parent gave 5 mL with Motrin. No new prescription sent by Dr. Hobbs. Medications: - Amoxicillin prescribed by urgent care (dose not specified in transcript) (new (prescribed by urgent care, not Dr. Hobbs)) - Ibuprofen (Motrin) dose not specified; used around the clock for pain/fever (ongoing (home use)) - Acetaminophen (Tylenol) dose not specified; used around the clock for pain/fever (ongoing (home use)) - (Prescription sent — specific medication not documented in Spruce) Key clinical quotes: "I'd keep an eye on the others for now, 12 hours after starting meds, he's much less contagious" "So it is possible that it was a false positive test and he has a viral infection. When a kid has strep, antibiotics usually make a big difference in 48 hours" "ahhhh, the stuffed up says more about possible viral illness too" Source: Spruce conversation t_2GDBR8BFPUO00