FEVER WITHOUT A SOURCE > 100.4 RECTAL

All urine is cathed!All temps are rectal

Antibiotics

Antibiotics

29 DAYS – 2 MONTHS< 28 DAYS

WBC <5 or >15Band/Neut >0.2CSF > 8 WBCsUA > 10 WBCsStool WBCs/hemeCXR

WBC <5 or >15Band/Neut >0.2CSF > 8 WBCsUA > 10 WBCsStool WBCs/hemeCXR if indicated

Parents ReliablePediatrician f/u next dayWell appearing pt

Anything in w/u + Everything in w/u neg

D/C

ADMIT

* Provider preference: Home with NO antibiotics or first dose Rocephin if LP was preformed; or obs pt for 1st 24hrs for blood/csf culture neg

*

WBC <5 or >15UA > 10 wbc

2 – 3 MONTHS

WBC <5 or >15UA - norm

WBC - wnlUA > 10 wbc

WBC - wnlUA - wnl

Stool > 5 WBCs/hemeCBC and UA + or Neg

LP & Blood CxParents ReliablePediatrician f/uWell appearing pt

OBS and hold antibiotics until stool studies return unless indication to treat blood or urine

LP & Blood Cx LP & Blood Cx

Ceftriaxone once if • Parents Reliable• Pediatrician f/u next day• Well appearing pt

Ceftriaxone and strongly consider OBS for blood & CSF cx neg for 24hrs

OR

•Ceftriaxone once and initiate outpatient UTI abx & valve w/u if:• Parents Reliable• Pediatrician f/u next day• Well appearing pt

Ceftriaxone and strongly consider OBS for blood & CSF cx neg for 24hrs

OR

Discharge with next day follow up and NO antibiotics!

*FUS > 100.4

*Most PEM providers define FUS > 102.2 after 2mos

FUS > 102.2

3 – 6 MONTHS

Ill Appearing

Source Identified?WBC <5 or >15Band/Neut >0.2CSF > 8UA > 10 WBCsStool > 5 WBCs/hemeCXR if indicated

• Treat Urine if +• Check CBC: send Blood Culture if CBC + one dose of Ceftriaxone is MD choice. Conservative Approach

UA Treat if +

D/CADMIT

YES NO

YES

NO

Accepted Fever Sources

1. HSV/Gingivostomatits2. Herpangina/Ulcerative Stomatits3. RSV4. Croup5. Flu6. Varicella7. Viral Exanthum (rash)8. Enterovirus coxsackie HFM dz, echo, rhino, entero,

Treatment Doses<28 Days: • Acyclovir = 60mg/kg/day divided q 8 hrs • Ampicillin = 50mg/kg• Gentamicin = dose is age dependent (use less than 8 days)• Cefotaxime = 50mg/kg (use if > 8 days)• Vacnyomycin = 15-20mg/kg

29 Days – 6mos• Ceftriaxone = 50mg/kg

Age 0-14 days 14-28 days28-60 days (pre

vaccine)28-60 days (post vaccine) 60-90 days > 90 days

Meningitis/SBI Prevalence

1/10 1/20 1/100 1/1000 1/1000-10,000 > 1/10,000