[Management of children with fever without localizing signs of an infection].
The management of infants and young children with fever without source (FWS) is a difficult challenge for pediatricians. Of 100 children with FWS, ten to 20 will have a serious bacterial infection (SBI) and 4 to 5% bacteriemia. Because no single aspect of the medical history, physical examination and laboratory parameters can reliably identify a child at increased risk for SBI, most management strategies now focus on identifying infants that are less likely to have SBI. The negative predictive value for 'low-risk criteria' SBI is close to 100%. Therefore, if it is possible to carry out a daily clinical examination, antibiotic treatment can be withheld from these children. For children who do not fulfill the low-risk criteria, antibiotics must be administered until the results of blood and urine samples and possibly CSF cultures have been obtained.
Département de pédiatrie, hôpitaux universitaires de Genève, Suisse. alain.gervaix@hcuge.ch
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Gervaix
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Caflisch
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Suter
D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D007223:Infant; D008487:Medical History Taking; D018579:Patient Selection; D010372:Pediatrics / Q000379:methods*; D010808:Physical Examination; D011237:Predictive Value of Tests; D012307:Risk Factors
D000900:Anti-Bacterial Agents