What is the role of antibiotics in the emergent management of pediatric patients with fever?

Updated: Jul 23, 2019
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Answer

Neonates with fever who undergo a routine workup to rule out sepsis should then receive 2 antibiotics as treatment for their potential septicemia: an aminopenicillin (eg, ampicillin) and a cephalosporin (eg, cefotaxime). [110] Local surveillance for ampicillin resistance is critical. [111, 112] Neonates may also receive antiviral treatment with acyclovir if they are at risk for neonatal herpes infection.

Administer antibiotics as indicated:

  • Age 0-28 days: Presumptive therapy with ampicillin and either gentamicin or a third-generation cephalosporin is indicated, while awaiting culture results

  • Age 29-56 days: Children ill enough to warrant hospitalization may be treated in the same way as younger neonates; most who meet low-risk criteria and are well enough to be discharged home do not require presumptive antibiotics; some clinicians may choose to administer ceftriaxone prior to ED discharge

  • Age 2-24 months: No presumptive antibiotic therapy is indicated for well-appearing children who do not have a defined bacterial source and who will be managed as outpatients

Corticosteroid therapy is not routinely indicated in the treatment of young infants with bacterial meningitis.


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