title: Outpatient therapy with ceftriaxone and oral cefixime for selected febrile children with sickle cell disease.
abstract: OBJECTIVE
  Children with sickle cell disease are at increased risk for bacterial sepsis and, when febrile, are usually hospitalized for intravenous antibiotic therapy pending results of blood cultures. In this study, we prospectively identified a group of febrile patients with sickle cell disease who were at low risk for sepsis and treated them with outpatient therapy.
  
  
  METHODS
  Children identified as low risk for sepsis were treated with an initial dose of intravenous ceftriaxone, followed by outpatient therapy with oral cefixime, and were monitored for 14 days after the initial visit. Compliance was assessed by phone calls to parents and by analysis of urine samples.
  
  
  RESULTS
  In 107 eligible febrile episodes (80 patients) over a 21-month period, no patient developed sepsis. One child developed bacteremia 3 days after completing the course of cefixime, and one had splenic sequestration on the fourth study day. Both patients did well. Side effects of cefixime were modest, and overall compliance was excellent (approximately 95%), although urine samples were returned by only 56% of parents.
  
  
  CONCLUSIONS
  We conclude that outpatient therapy is safe and effective in febrile patients with sickle cell disease who meet the criteria for a low risk of sepsis.
authors.affiliation: Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Williams
authors.forename: J A
authors.initials: JA
authors.lastname: Wilimas
authors.forename: S C
authors.initials: SC
authors.lastname: Harris
authors.forename: S W
authors.initials: SW
authors.lastname: Day
authors.forename: R M
authors.initials: RM
authors.lastname: Dancy
authors.forename: W C
authors.initials: WC
authors.lastname: Wang
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications*; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016470:Bacteremia / Q000517:prevention & control; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D020682:Cefixime; D002439:Cefotaxime / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005334:Fever; D006801:Humans; D007223:Infant; D008297:Male; D010045:Outpatients; D010349:Patient Compliance
chemical_list: D000890:Anti-Infective Agents; D002511:Cephalosporins; D002443:Ceftriaxone; D020682:Cefixime; D002439:Cefotaxime