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1. Algorithm
for the Management of a Previously Healthy Infant 0 - 90 Days
of Age with Fever Without Source, Greater than or equal to
38.0 C
Toxic Appearing, 28 - 90 Days of Age & "Low-Risk"
*
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Yes
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No
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| Admit to Hospital
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Outpatient
Management |
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Blood Culture
Urine Culture
Lumbar Puncture
Parenteral Antibiotics
Chest X-ray** |
Option 1
Blood Culture
Urine Culture
Lumbar Puncture
Ceftriaxone 50 mg/kg IM
Re-evaluation within 24 hours |
Option 2
Blood Culture
Urine Culture
Re-evaluation within 24 hours |
** Chest x-ray
if signs of pneumonia: respiratory distress, abnormal
breath sounds, tachypnea, pulse ox <95%.
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Follow-up of Low Risk Infants treated as outpatients with
positive cultures:
B/C positive (pathogen): Admit for sepsis evaluation
and parenteral antibiotic therapy pending results.
U/C positive (pathogen): Persistent fever: Admit for sepsis
evaluation and parenteral antibiotic therapy pending results.
Outpatient antibiotics if afebrile and well.
* Low Risk Criteria for Febrile Infants:
Clinical Criteria:
Previously healthy, term infant with uncomplicated nursery
stay
Non-toxic clinical appearance
No focal bacterial infection on examination (except otitis
media)
Laboratory Criteria:
WBC count 5 - 15,000/mm3, <1,500 bands/mm3 or band/neutrophil
ratio <0.2
Negative Gram stain of unspun urine (preferred) or negative
urine leukocyte esterase & nitrite, or <5 WBCs/hpf
When diarrhea present: <5 WBCs/hpf in stool
CSF: <8 WBCs/mm3 & negative Gram stain (Option 1 only)
LJ Baraff 07/01/00
2. Algorithm for the Management of a Previously Healthy
Child
3 - 36 Months of Age with Fever Without Source
Child Appears Toxic
Yes
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No
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Admit To Hospital
Sepsis work-up
Parenteral antibiotics |
Temp. higher than 39.0 C? |
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Yes
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No
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1a) Urine LE and Nitrite or
Urinalysis and Urine Culture:
All males equal to or younger than 6 months and uncircumcised
males 6-12 months of age
All females younger than 12 months of age
If urine screening test positive: Outpatient antibiotics
(Oral third generation cephalosporin)
1b) Urine LE and Nitrite or Urinalysis and hold
urine culture
Circumcised males 6-12 months of age and all females 12-24
months of age
If urine screening test positive: Send urine culture and
outpatient antibiotics (Oral third generation cephalosporin)
2) For infants and children who have not
received the conjugate S. pneumoniae vaccine:
Temperature equal to or higher than 39.5 C: Obtain WBC
count (or ANC) and hold blood culture
If WBC count equal to or higher than15,000 (or ANC equal
to or higher than10,000):
Send blood culture
Ceftriaxone 50 mg/kg up to 1 gram
3) Chest x-ray: If SaO2 less than 95%, respiratory distress,
tachypnea rales, or
Temperature -higher than 39.5 and WBC Count higher than
20,000 (see #3)
4) Acetaminophen: 15 mg/kg/dose q4h or Ibuprofen 10 mg/kg/dose
q6h for fever
5) Return if fever persists for more than 48 hours or
condition deteriorates
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1) No diagnostic tests or
antibiotics
2) Acetaminophen 15 mg/kg/dose q4h or Ibuprofen 10 mg/kg/dose
q6h for fever
3) Return if fever persists for more than 48 hours or
deteriorates |
Follow-up of children treated as outpatients with positive
cultures:
B/C positive (pathogen): Admit if febrile or ill appearing
Outpatient antibiotics if afebrile and well
U/C positive (pathogen): Admit if febrile or ill appearing
Outpatient antibiotics if afebrile and well
LJ Baraff 07/01/00
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