Antimicrobial treatment of occult bacteremia: a multicenter cooperative study.
This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS)
Bass
J W
JW
Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI 96859-5000.
Steele
R W
RW
Wittler
R R
RR
Weisse
M E
ME
Bell
V
V
Heisser
A H
AH
Brien
J H
JH
Fajardo
J E
JE
Wasserman
G M
GM
Vincent
J M
JM
D000284:Administration, Oral; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use*; D019980:Amoxicillin-Potassium Clavulanate Combination; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D002675:Child, Preschool; D002969:Clavulanic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005334:Fever; D005500:Follow-Up Studies; D006192:Haemophilus Infections / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007964:Leukocytosis; D008297:Male; D008589:Meningococcal Infections / Q000188:drug therapy; D015999:Multivariate Analysis; D011008:Pneumococcal Infections / Q000188:drug therapy; D011446:Prospective Studies; D012044:Regression Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002969:Clavulanic Acids; D019980:Amoxicillin-Potassium Clavulanate Combination; D002443:Ceftriaxone; D000658:Amoxicillin