The need for a second dose of ceftriaxone in febrile infants age 4-8 weeks.
OBJECTIVE
To determine if a second intramuscular injection of ceftriaxone was necessary in febrile infants who meet low-risk criteria for outpatient therapy.


METHODS
Children's Hospital Emergency Department.


METHODS
Febrile infants 4-8 weeks of age.


METHODS
Outpatient treatment criteria included non-toxic appearance, no identifiable source for infection on physical examination, CSF WBC > or = 10/mm3, peripheral WBC < or = 15,000/mm3, normal UA, and normal chest radiograph study, if obtained. Additional requirements included a reliable caretaker and re-evaluation in 24 hours. Infants who met these criteria received intramuscular ceftriaxone 50 mg/kg with instructions to follow-up in 24 hours. At the follow-up visit, infants with no identifiable source for infection and negative cultures received a second dose of intramuscular ceftriaxone and were discharged. Cultures were read at 48 hours and at the conclusion of the study. Medical records were reviewed to identify delayed complications.


RESULTS
172 infants were enrolled. The mean age was 45 days. All CBC, UA, CSF analyses were normal. Chest radiographs were obtained in 56 (30%) infants; all were normal. One (.05%) patient was admitted at the follow-up visit. The mean time to follow-up was 25 hours. Two positive cultures were identified at the re-evaluation visit; one blood culture grew Salmonella and a urine culture grew E. coli. The CSF cultures were all negative at follow-up and remained negative.


CONCLUSIONS
Febrile infants 4-8 weeks of age who meet outpatient therapy criteria and have negative cultures and no identifiable source for infection at 24 hours may not require the second dose of intramuscular ceftriaxone.
Allen
S E
SE
Emergency Medicine Section, Cincinnati Children's Hospital, OH, USA.
Walsh-Kelly
C M
CM
Hennes
H H
HH
D000553:Ambulatory Care; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007273:Injections, Intramuscular; D010346:Patient Care Management; D011446:Prospective Studies
D002511:Cephalosporins; D002443:Ceftriaxone