Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone

Time to Detection of Positive Cultures in 28- to 90-Day-Old Febrile Infants

“…Twenty-one of these 24 pathogens (including all positive blood cultures) occurred in patients classified as high-risk according to previously established criteria. 15 One might expect that high-risk patients have a heavier bacterial load or more virulent organism and are less likely to have delayed growth. However, this was not the case and is likely attributable to the fact that most of the cultures that took Ͼ24 hours to identify were urine cultures, and most patients with urinary tract infections had a positive urinalysis classifying them as high-risk.…”

“…Several management protocols have been published. 9,10,15,[17][18][19] Some studies have shown that selected febrile infants may safely be managed as outpatients without the use of antibiotics. 10,18,19 Those infants had to meet more stringent risk criteria than ours to qualify for outpatient management, and 75% of the most recent study population of infants 29 to 60 days old using this strategy were admitted.…”

“…10,18,19 Those infants had to meet more stringent risk criteria than ours to qualify for outpatient management, and 75% of the most recent study population of infants 29 to 60 days old using this strategy were admitted. 19 In our population, the strategy of Baskin et al 15 was used, so all children were treated with antibiotics but only 39% (42% of 28-to 60-day-old infants and 34% of 61-to 90-day-old infants) were admitted. This approach treats more infants but reduces the proportion hospitalized, which may decrease the cost and potential morbidity associated with hospitalization.…”

“…15 Infants were considered to be at high risk by clinical criteria if they had an identified focal bacterial infection or preexisting illness or were judged by the treating clinician to be ill appearing or to require hospital admission. Patients were categorized as high risk for SBI by laboratory criteria if they had any of the following laboratory findings: 1) peripheral leukocyte count of Ն20 000/mm 3 , 2) urinalysis demonstrating Ն10 leukocytes per high-powered field, or 3) CSF leukocyte count Ն10 white blood cells/mm 3 .…”

“…In 2 studies, low-risk infants were treated as outpatients with empiric antibiotics. 9, 15 Baskin et al 15 showed that lowrisk febrile infants 28 to 89 days of age can be managed safely with the administration of a parenteral dose of ceftriaxone and discharged from the hospital with a scheduled follow-up within 24 hours for clinical reevaluation and a second dose of ceftriaxone to provide antibiotic coverage while the blood, urine, and cerebrospinal fluid (CSF) cultures incubate. This strategy is based on the assumptions that most pathogens are identified within 48 hours and 2 doses of ceftriaxone will provide sufficient protection for those children whose pathogens are identified later.…”