Management

The appropriate management of young febrile infants presents another area of disagreement.21 There appears to be no "community standard of practice" regarding the need for hospitalization; some physicians hospitalize all febrile infants younger than age 3 months, and others hospitalize only those under age 1 month. Because the differentiation between sick and well infants is so difficult, all such febrile infants need extensive septic workups. The decision not to hospitalize a small febrile infant must be made after careful clinical and appropriate laboratory assessment and after ensuring the reliability of follow-up.

Current management strategies include the administration of ceftriaxone at a dose of 50 mg/kg to febrile infants between 1 and 3 months of age who are judged to be at low risk for serious bacterial infection when the above criteria are used. 22 A caretaker with a telephone is an additional criterion for such outpatient management. Similarly, Baskin and colleagues23 proposed inpatient management of febrile infants who are between 2 and 4 weeks of age and also judged to be at low risk, using parenteral ceftriaxone and only 24 h of observation. Infants could be discharged if cultures were negative after 24 h.

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