Treatment

EMERGENCY The treatment plan for febrile infants, like the diagnostic evaluation, must be stratified by patient age and directed toward the age-related and organ system-specific probable pathogens (Fig 118-1 and Fig 118-2 and Table 118-5). Febrile neonates, after being fully evaluated for sepsis as described above, should be stabilized with supportive care and treated with broad-spectrum intravenous antibiotics to cover group B streptococcus, E. coli, Listeria monocytogenes, and Enterococcus sp. pending culture results. Optimal therapy includes ampicillin 100 mg/kg and either cefotaxime or ceftriaxone 50 mg/kg IV, with initial doses given in the ED prior to admission. Young infants aged 30 to 90 days considered to be high risk for SBI based on the foregoing clinical or laboratory parameters should be similarly evaluated for sepsis and treated with ampicillin and either cefotaxime or ceftriaxone to cover both neonatal and community-acquired pathogens. Young infants aged 30 to 90 days considered low risk for SBI based on clinical and laboratory parameters may be reasonably managed as outpatients in two ways if follow-up is feasible based on physician judgment of parental reliability and availability of a home telephone and source of transportation. The more traditional and conservative approach is to perform a lumbar puncture on all such young infants to exclude bacterial and aseptic meningitis definitively and treat with ceftriaxone 50 mg/kg IM prior to discharge.27 Alternatively, it has been shown that well-appearing infants in this age group considered low risk may be safely managed with selective lumbar puncture and without antibiotics, providing strict adherence to clinical, laboratory, and follow-up criteria is maintained. 28

FIG. 118-1. Management scheme for febrile infants aged 0 to 90 days. Abbrevations: ED, emergency department.

FIG. 118-2. Management scheme for febrile infants aged S months or older. Abbrevations: ED, emergency department; HIB, Haemophilus influenzae type b.

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