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PEDIATRICS Vol. 100 No. 1 July 1997, pp. 128-134
| The first 300 words of the full text of this article appear below. |
Recently published "practice
guidelines"1,2 and randomized antibiotic
trials3,4 reflect a climate of increased diagnostic testing, more frequent treatment, and more invasive (ie, parenteral rather than oral) treatment of febrile children 3 to 36 months of age.
For children in this age group with a temperature 
39.0°C, the
guidelines1,2 suggest a white blood cell (WBC) count and
provide two options with respect to obtaining a blood culture: all such
children or those whose WBC count is 15 000/mm2. Culture
of urine obtained by catheterization or suprapubic aspiration is
recommended for all boys <6 months and all girls <24 months. The
guidelines recommend empiric treatment with ceftriaxone, once again
with two options: treat all such children or those whose WBC count is
15 000/mm2. These practice guidelines are based on a
meta-analysis that pooled data from both randomized controlled trials
and observational (nonexperimental) studies of clinical outcomes in
young febrile children, and on the views of an expert panel chosen by
the senior author.1,2 Although the guidelines have not been
officially endorsed by any professional organization, they were
developed by authors who are widely recognized in the field and thus
could have an important impact on both clinical practice and health care policy.
The clinical setting is that of a child with acute onset (
4 days) of
fever who does not appear "toxic" (ie, seriously ill) and has no
apparent focus of bacterial infection (otitis media, pneumonia,
osteomyelitis/septic arthritis, lymphadenitis, cellulitis, dysentery-like enteritis, or meningitis) after a history is obtained and a physical examination is performed. When confronted with such a
child, the clinician must make a series of decisions:
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