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IS IT WISE TO GIVE THE FEBRILE CHILD AN ANTIBIOTIC?

Only 3 to 15% of febrile children have bacteremia, and it is hard to tell which do. Furthermore, untreated children could suffer major septic complications, such as meningitis, so clinicians often prescribe antibiotics before establishing the diagnosis.

In this study, 955 children aged 3 to 36 months, with temperatures greater than 39 degrees C, were randomly given either oral amoxicillin or placebo. Of the 2.8% of the children who were bacteremic, the treated group had a faster resolution of fever but did not experience fewer major infectious complications; furthermore, diarrhea developed more frequently in the treated group.

Despite its size, the study was not large enough to consider the value of treatment in subgroups of children who may be at especially high risk of bacteremia and bacteremic complications: children less than 24 months of age, and children with elevated white counts (greater than 15,000 in particular). Also, the study was not large enough to prove convincingly that there was no real reduction in major infectious complications.

While the use of antibiotics undoubtedly will not benefit most febrile children, the clinician still is justified in using antibiotics when clinical criteria suggest the risk of bacteremia is highest.

— ALK

Published in Journal Watch General Medicine November 10, 1987

Citation(s):

Jaffe D M; Tanz R R; Davis A T; Henretig F; Fleisher G. Antibiotic administration to treat possible occult bacteremia in febrile children. N Engl J Med 1987 Nov 5 317 1175-1180.

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