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CEFTRIAXONE VS. AMOXICILLIN FOR FEBRILE CHILDREN.

Do antibiotics prevent serious bacterial illness in young children with fever? This randomized, multicenter study compared a single dose of intramuscular ceftriaxone with two days of oral amoxicillin in 6329 children with nonfocal febrile illness and 351 with otitis media.

Patients with otitis also received eight more days of oral amoxicillin. Ages ranged from 3 to 36 months, and temperatures from 39 to 41.8 degrees C.

Of the 6637 children who had blood cultures, 192 (3 percent) had bacteremia. The most common isolates were S. pneumoniae (164) and H. influenzae type b (9). Of the 101 bacteremic children given ceftriaxone, 3 were classified as having "probable" bacterial complications (meningitis in 2 and osteomyelitis in 1). Of the 91 given amoxicillin, 5 had "definite" complications (meningitis in 3, pneumonia in 1, and salmonella sepsis in 1), and 1 had probable septic arthritis. Overall rates of serious infection did not differ by antibiotic, but, after exclusion of probable cases, ceftriaxone was statistically better.

Comment: The authors conclude that if a clinician wants to use antibiotics presumptively to prevent bacteremic complications, ceftriaxone is a safe, effective alternative to amoxicillin. However, an editorialist raises methodologic concerns about the study, including the exclusion of several ceftriaxone-treated cases that many clinicians would define as having bacteremic sequelae. She also questions the need for presumptive antibiotics, citing ceftriaxone's effect on gut flora, the emergence of life-threatening drug-resistant pathogens, and the virtual disappearance of H. influenzae type B infection. (This study was supported by the makers of ceftriaxone.)

— RH Pantell

Published in Journal Watch General Medicine June 10, 1994

Citation(s):

Long SS. Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia. J Pediatr 1994 Apr 124 585-588.

• Medline abstract (Free)

Fleisher GR et al. Antibiotic therapy in febrile children: Best-laid schemes. J Pediatr 1994 Apr 124 504-512.

• Medline abstract (Free)