Pediatric Fever References
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RELATIONSHIP OF TEMPERATURE PATTERN AND SERIOUS BACTERIAL INFECTIONS IN
INFANTS 4 TO 8 WEEKS OLD 24 TO 48 HOURS AFTER ANTIBIOTIC TREATMENT
Bonadio, W.A., et al, Ann Emerg Med 20(9) :1006, September 1991

Background:  It has been suggested that outpatient management with daily
administration of intramuscular ceftriaxone may be appropriate for
selected febrile infants aged 4-8 weeks.  However, indications for
continued outpatient management or hospitalization after 24- and 48- hour
follow-up have not been identified. Methods:  This prospective study, from
the Children's Hospital of Wisconsin in Milwaukee, examined the
correlation between serious bacterial infections and temperature patterns
in 161 febrile infants aged 4-8 weeks who were hospitalized for empiric
parenteral antibiotic treatment with standard doses of ceftriaxone or
cefotaxime.  Rectal temperatures were measured every four hours for 48
hours.  Results:  Serious bacterial infections (bacterial meningitis,
bacteremia, urinary tract infections or bacterial enteritis) were
documented in 11% (18 cases), and all of the isolates were sensitive to
the study antibiotics.  Only one infant with a serious bacterial infection
(an isolated UTI) manifested fever during the study period. There were no
statistically significant differences between the prevalence of fever
during the study period in patients with and without serious bacterial
infections (5.5% and 18.8%, respectively), and all repeat cultures
performed during hospitalization in children with serious bacterial
infections were negative.  Conclusions:  These findings suggest that, in
febrile infants aged 4-8 weeks, temperature patterns for up to 48 hours
after initiation of parenteral cephalosporins do not differentiate
patients with and without serious bacterial infections, and that
persistent fever is more likely in infants without serious bacterial
infections.  4 references *Copyright 1992 by Emergency Medical Abstracts -
All Rights Reserved                                     01/92 - #33

Reprint information:
William A. Bonadio, MD
1240 Pioneer Trail
Waukesha, WI  53186