PEDIATRICS Vol. 72 No. 5 November 1983, pp. 608-612
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Treatment of Occult Bacteremia: A Prospective Randomized Clinical Trial

William L. Carroll MD1, Michael K. Farrell MD1, Jonathan I. Singer MD1, Mary Anne Jackson MD1, Jeffrey S. Lobel MD1, and Edward D. Lewis MD1

1 From the Department of Pediatrics, University of Cincinnati College of Medicine and Children's Hospital Medical Center, Cincinnati

Antibiotic therapy for children without foci of infection and at risk for bacteremia is controversial. A prospective randomized clinical trial was conducted using expectant antibiotic therapy in children at risk for bacteremia. A total of 96 children (aged 6 to 24 months) with temperature of more than 40°C, no identifiable source of infection, and a leukocyte count ge15,000/µL and/or sedimentation rate ge30 were enrolled. The following tests were performed on all children: blood culture, chest roentgenogram, urinalysis, and urine culture. A lumbar puncture was performed if a child was 12 months or less. Patients were randomized to receive either no antibiotic therapy or Bicillin C-R, 50,000 U/kg intramuscularly, followed by penicillin V, 100 mg/kg/d, orally four times a day for three days. Patients were examined at 24 and 72 hours. Fifty patients were treated expectantly and 46 received no antimicrobial therapy. Ten of the 96 patients were bacteremic (nine had Streptococcus pneumoniae, one had Haemophilus influenzae). Four of the five children treated for bacteremia showed improvement at the first follow-up visit (afebrile and no obvious focus of infection). The five untreated patients showed no improvement; four patients developed focal infections (two had meningitis, two had otitis media) (P le .05, Fisher exact test). No complications of expectant therapy were detected. Thus, expectant antibiotic therapy for children who have no obvious source of infection and who meet these criteria associated with occult bacteremia is warranted.

Key Words: bacteremia • pneumococcus

Accepted on February 15, 1983




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