Relationship of temperature pattern and serious bacterial infections in infants 4 to 8 weeks old 24 to 48 hours after antibiotic treatment.
OBJECTIVE
A new management approach to selected febrile infants 4 to 8 weeks old evaluated for possible sepsis is outpatient ceftriaxone therapy, with subsequent re-evaluation 24 to 48 hours after presentation. This study assessed whether the temperature profile of such infants during the 24- to 48-hour period after treatment distinguished those with from those without serious bacterial infections (SBIs).


METHODS
Prospective, descriptive clinical study.


METHODS
One hundred sixty-one febrile infants 4 to 8 weeks old.


METHODS
An urban pediatric emergency department and hospital.


RESULTS
All infants underwent a sepsis evaluation (lumbar puncture, CBC/blood culture, and urinalysis/urine culture) and were hospitalized for at least 48 hours. Temperatures were measured on presentation and then every four hours during hospitalization. All infants received parenteral third-generation cephalosporin antibiotic therapy, and none received antipyretic medication unless fever was documented. Fever (rectal temperature of more than 38.0 C) was documented during the 24- to 48-hour period after presentation in 28 infants (17.6%)--one of a total of 18 infants (5.6%) with SBI and 27 of a total of 143 infants (19%) without SBI (alpha, more than .2: power .30). All bacterial isolates in cases of SBI were susceptible to third-generation cephalosporin antibiotics. All repeat blood and urine cultures that were performed in infants with bacteremia or urinary tract infections, respectively, were negative 24 hours after presentation.


CONCLUSIONS
Infants 4 to 8 weeks old who remain febrile during the 24 to 48-hour period after presentation and initiation of parenteral antibiotic therapy are less likely to have SBI. This study did not have sufficient power for this difference to be statistically significant.
Bonadio
W A
WA
Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee.
Lehrmann
M
M
Hennes
H
H
Smith
D
D
Ruffing
R
R
Melzer-Lange
M
M
Lye
P
P
Isaacman
D
D
D001831:Body Temperature; D002443:Ceftriaxone / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005334:Fever / Q000453:epidemiology* / Q000209:etiology; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology
D002443:Ceftriaxone