fever without focus line mangement

8/8/2019 FEVER without focus line mangement

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Fever without focus


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EVALUATIONAND

MANAGEMENT

Algorithm for

management ofchildren aged 3 to

36 months with

fever without focus

who do not appearextremely ill.


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managemen o

children aged 3 to 36months Child who appears extremely ill on initial evaluation or on followup: Admitto the hospital for parenteral antibiotics after appropriate laboratory

evaluation.

Well-appearing child aged 3 to 24 months with temperature less than 39C or aged 2 to 3 years with temperature less than 39.5 C: No diagnostic

tests need to be initiated.The caregiver should be instructed to take the child

back to the physician if the fever persists for more than 48 hours or if the

childs condition deteriorates.

Child aged 3 to 24 months with temperature exceeding 39 C or aged 2 to

3 years with temperature exceeding 39.5 C: Urine culture is suggested for

boys younger than 12 months and forgirls younger than 2 years.A complete

blood cell count and blood culture should be obtained. Ceftriaxone should be

given if the ANC exceeds 10,000 cells/mm3 or if the WBC count exceeds

15,000 cells/mm3. Children should be reevaluated in 24 hours.If the child is

afebrile and well on follow-up and the cultures show no growth, no further

therapy is necessary.


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managemen o

children aged 3 to 36monthsChild with positive blood culture: Reevaluation should occur in any child whose bloodculture is presumptively positive.

If the blood is found to contain N. meningitidis or H. influenzae (which has been rare

since the advent of H. influenzae b immunization), a CSF sample and a repeat blood

culture should be obtained, and the child should be admitted to the hospital forparenteral antibiotics, pending the results of the cultures.

The child with OPB who appears well and is afebrile can be managed as an

outpatient with parenteral ceftriaxone followed by oral antibiotics according to the

sensitivity of the organism.

Because of the concern of pneumococcal resistance to penicillin, a second dose of

intramuscular ceftriaxone may be given until penicillin sensitivity is documented.Ifthe culture is positive for nontyphoidal

Salmonella organisms and the child is younger than 3 months, full sepsis evaluation

and intravenous antibiotics are recommended.

Oral antibiotics and close follow-up is recommended for older children.


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managemen o

children aged 3 to 36months

Child with positive urine culture: Ifthe child is afebrile and appears

well, treatment with oral antibiotics

is recommended, according to the

sensitivity of the organism


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CHILDRENOLDER

THAN 36 MONTHSEvaluation and management of ill-appearing children

older than

36 months with FWF are similar to those of younger

children.An

important exception is that blood cultures are not routinely

ordered to screen for occult bacteremia.The clinician can

observe and reevaluate a well-appearing older child with

temperature exceeding 39 C without first obtaining

blood cultures. Close attention

should be paid to environmental exposures and ill

contacts, because of the high likelihood of increased

contacts in this school-aged cohort.


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ANTIPYRETIC

THERAPYThe dosage is 10 to 15 mg/kg per dose givenevery 4 hours, with a maximum single dose of

650 mg.

Aspirin is not recommended, because of itsassociation with Reye syndrome.

Ibuprofen is a nonsteroidal antiinflammatory

agent that is effective in reducing fever.The

dosage is 5 to 10 mg/kg every 6 to 8 hours.It issafe for most patients, except for those with

renal disease or severe dehydration.

GastrointestinalUpset is reported in 10% to

15% of patients


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ANTIPYRETIC

THERAPYExt r l li g i t r t

f tr lli g f r .In f rile

tient , external ling ay e fli itedeffecti eness ecause it

causescutaneous asoconstriction

andshi ering, othof hichcontri ute to aintaining or raising

thecore temperature.


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CEFTRIAXONECeftriaxone is useful for outpatienttherapy because adequate tissue levels

are achieved for 24 hours with a single

intramuscular dose and because it isactive against the typical pathogens

causing SBI.

The usual dose is 50 to 75 mg/kg/day

when given intramuscularly.It is

estimated that the risk of anaphylaxis is

10% to 15% in patients with penicillin

allergy.


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CEFTRIAXONEAntibiotic therapy should be adjusted according

to in vitro susceptibility and patient response to

treatment.Penicillin-resistant S. pneumoniae

may be a concern for patients who have recentlybeen treated with antibiotics, attend day care, or

live in communities with

high rates of penicillin resistance. High-dose oral

amoxicillin (80 to 90 mg/kg/day) is recommendedfor patients with nonmeningeal infections

presumed to be caused by resistant

pneumococcal bacteria.

fever without focus line mangement

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