Pediatric fever of uncertain source: Difference between revisions
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Note: Preemies - Count age by estimated postconception date (not by actual delivery date) for 1st 90d | Note: Preemies - Count age by estimated postconception date (not by actual delivery date) for 1st 90d | ||
=== Management of patients who are well-appearing, vaccinated, and no clinical source of fever === | |||
{| border="1" cellspacing="1" cellpadding="1" style="width: 500px;" | |||
|- | |||
| Age Group | |||
| Evaluation | |||
| Treatment | |||
|- | |||
| | |||
0-28d, ≥38C | |||
SBI incidence of ill appearing: 13%–21% | |||
if not ill appearing: <5% | |||
| | |||
CBC, blood Cx | |||
UA, Ucx | |||
CSF cell count, GS, Cx | |||
CXR (only if resp sx) | |||
Stool testing (if diarrhea present) | |||
| | |||
Admit | |||
Ampicillin 50mg/kg + (cefotaxime 50mg/kg or gentamicin 2.5mg/kg) | |||
|- | |||
| | |||
29-56d, ≥ 38.2 (100.8) (Philadelphia Protocol) | |||
<br/>SBI incidence of ill appearing: 13%–21% | |||
if not ill appearing: <5% | |||
| Same as for neonates | |||
| | |||
Discharge if: | |||
1. WBC <15K but >5K and <20% bands | |||
2. UA negative | |||
Admit if above are not met and treat with CTX 50mg/kg if CSF normal, 100mg/kg if signs of meningitis | |||
|- | |||
| | |||
57d-6mo, ≥38 | |||
Non-UTI SBI incidence is estimated to be negligible | |||
<span class="Apple-style-span" style="line-height: 17px;">UTI is 3%–8%</span> | |||
| | |||
UA and Ucx alone | |||
OR | |||
treat 57-90d using Philadelphia Protocol | |||
| | |||
Discharge if negative | |||
Treat UTI w/ cefixime 8mg/kg/d or cefpodoxime 10mg/kg/d divided into BID or cefdinir 14mg/kg/d x 7-10days as outpatient | |||
Admit and tx with CTX if fail criteria for d/c | |||
|- | |||
| | |||
57d-6mo, ≥39 (102.2) | |||
SBI incidence is estimated <1%; | |||
non-UTI SBI incidence is estimated to be negligible. | |||
UTI is 3%–8% | |||
| | |||
UA and Ucx alone | |||
OR | |||
UA and Ucx + CBC + blood cx | |||
| | |||
: | |||
Discharge if negative | |||
Treat for UTI as above | |||
If WBC>15K consider treatment with CTX 50 mg/kg IV/IM, and follow-up in 24hr | |||
If WBC>20K consider CXR and CSF | |||
|- | |||
| | |||
6–36 mo | |||
Non-UTI SBI incidence is <0.4% | |||
UTI in girls ≤8% | |||
UTI in boys (<12 mo) ≤ 2% | |||
Uncircumcised boys (1–2 y) remains 2% | |||
| | |||
UA and Ucx in: | |||
(girls 6-24mo) | |||
(circ 6-12mo) | |||
(uncirc 6-24mo) | |||
| | |||
Discharge if negative | |||
Treat for UTI as above as outpatient | |||
|- | |||
| >36mo | |||
| No further w/u is routinely necessary | |||
| <br/> | |||
|} | |||
Note: Preemies - Count age by estimated postconception date (not by actual delivery date) for 1st 90d | |||
== See Also == | == See Also == |
Revision as of 19:15, 1 March 2012
Management of patients who are well-appearing, vaccinated, and no clinical source of fever
Age Group | Evaluation | Treatment |
0-28d, ≥38C SBI incidence of ill appearing: 13%–21% if not ill appearing: <5% |
CBC, blood Cx UA, Ucx CSF cell count, GS, Cx CXR (only if resp sx) Stool testing (if diarrhea present) |
Admit Ampicillin 50mg/kg + (cefotaxime 50mg/kg or gentamicin 2.5mg/kg) |
29-56d, ≥ 38.2 (100.8) (Philadelphia Protocol)
if not ill appearing: <5%
|
Same as for neonates |
Discharge if: 1. WBC <15K but >5K and <20% bands 2. UA negative Admit if above are not met and treat with CTX 50mg/kg if CSF normal, 100mg/kg if signs of meningitis |
57d-6mo, ≥38 Non-UTI SBI incidence is estimated to be negligible UTI is 3%–8%
|
UA and Ucx alone OR treat 57-90d using Philadelphia Protocol |
Discharge if negative Treat UTI w/ cefixime 8mg/kg/d or cefpodoxime 10mg/kg/d divided into BID or cefdinir 14mg/kg/d x 7-10days as outpatient Admit and tx with CTX if fail criteria for d/c |
57d-6mo, ≥39 (102.2) SBI incidence is estimated <1%; non-UTI SBI incidence is estimated to be negligible. UTI is 3%–8% |
UA and Ucx alone OR UA and Ucx + CBC + blood cx |
Discharge if negative Treat for UTI as above If WBC>15K consider treatment with CTX 50 mg/kg IV/IM, and follow-up in 24hr If WBC>20K consider CXR and CSF |
6–36 mo Non-UTI SBI incidence is <0.4% UTI in girls ≤8% UTI in boys (<12 mo) ≤ 2% Uncircumcised boys (1–2 y) remains 2% |
UA and Ucx in: (girls 6-24mo) (circ 6-12mo) (uncirc 6-24mo) |
Discharge if negative Treat for UTI as above as outpatient |
>36mo | No further w/u is routinely necessary |
Note: Preemies - Count age by estimated postconception date (not by actual delivery date) for 1st 90d
Management of patients who are well-appearing, vaccinated, and no clinical source of fever
Age Group | Evaluation | Treatment |
0-28d, ≥38C SBI incidence of ill appearing: 13%–21% if not ill appearing: <5% |
CBC, blood Cx UA, Ucx CSF cell count, GS, Cx CXR (only if resp sx) Stool testing (if diarrhea present) |
Admit Ampicillin 50mg/kg + (cefotaxime 50mg/kg or gentamicin 2.5mg/kg) |
29-56d, ≥ 38.2 (100.8) (Philadelphia Protocol)
if not ill appearing: <5%
|
Same as for neonates |
Discharge if: 1. WBC <15K but >5K and <20% bands 2. UA negative Admit if above are not met and treat with CTX 50mg/kg if CSF normal, 100mg/kg if signs of meningitis |
57d-6mo, ≥38 Non-UTI SBI incidence is estimated to be negligible UTI is 3%–8%
|
UA and Ucx alone OR treat 57-90d using Philadelphia Protocol |
Discharge if negative Treat UTI w/ cefixime 8mg/kg/d or cefpodoxime 10mg/kg/d divided into BID or cefdinir 14mg/kg/d x 7-10days as outpatient Admit and tx with CTX if fail criteria for d/c |
57d-6mo, ≥39 (102.2) SBI incidence is estimated <1%; non-UTI SBI incidence is estimated to be negligible. UTI is 3%–8% |
UA and Ucx alone OR UA and Ucx + CBC + blood cx |
Discharge if negative Treat for UTI as above If WBC>15K consider treatment with CTX 50 mg/kg IV/IM, and follow-up in 24hr If WBC>20K consider CXR and CSF |
6–36 mo Non-UTI SBI incidence is <0.4% UTI in girls ≤8% UTI in boys (<12 mo) ≤ 2% Uncircumcised boys (1–2 y) remains 2% |
UA and Ucx in: (girls 6-24mo) (circ 6-12mo) (uncirc 6-24mo) |
Discharge if negative Treat for UTI as above as outpatient |
>36mo | No further w/u is routinely necessary |
Note: Preemies - Count age by estimated postconception date (not by actual delivery date) for 1st 90d
See Also
Source
Tintinalli