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FEVER WITHOUT A SOURCE > 100.4 RECTAL. < 28 DAYS. 29 DAYS – 2 MONTHS. WBC <5 or >15 Band/ Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR. WBC <5 or >15 Band/ Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR if indicated. Anything in w/u +.

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slide1

FEVER WITHOUT A SOURCE > 100.4 RECTAL

< 28 DAYS

29 DAYS – 2 MONTHS

WBC <5 or >15

Band/Neut >0.2

CSF > 8 WBCs

UA > 10 WBCs

Stool WBCs/heme

CXR

WBC <5 or >15

Band/Neut >0.2

CSF > 8 WBCs

UA > 10 WBCs

Stool WBCs/heme

CXR if indicated

Anything in w/u +

Everything in w/uneg

Parents Reliable

Pediatrician f/u next day

Well appearing pt

Antibiotics

Antibiotics

*

ADMIT

D/C

* Provider preference:

Home with NO antibiotics or first dose

Rocephin if LP was preformed; or obs pt

for 1st 24hrs for blood/csf culture neg

All urine is cathed!

All temps are rectal

slide2

*FUS > 100.4

*Most PEM providers define FUS > 102.2 after 2mos

2 – 3 MONTHS

WBC - wnl

UA - wnl

WBC - wnl

UA > 10 wbc

WBC <5 or >15

UA > 10 wbc

WBC <5 or >15

UA - norm

Stool > 5 WBCs/heme

CBC and UA + or Neg

Parents Reliable

Pediatrician f/u

Well appearing pt

LP & Blood Cx

LP & Blood Cx

LP & Blood Cx

Ceftriaxone and strongly consider OBS for blood & CSF cxneg for 24hrs

Ceftriaxone and strongly consider OBS for blood & CSF cxneg for 24hrs

  • Ceftriaxoneonce if
  • Parents Reliable
  • Pediatrician f/u next day
  • Well appearing pt
  • Ceftriaxone once and initiate outpatient UTI abx & valve w/u if:
  • Parents Reliable
  • Pediatrician f/u next day
  • Well appearing pt

Discharge with next day follow up and NO antibiotics!

OBS and hold antibiotics until stool studies return unless indication to treat blood or urine

OR

OR

slide3

FUS > 102.2

3 – 6 MONTHS

Ill Appearing

YES

NO

UA

Treat if +

YES

WBC <5 or >15

Band/Neut >0.2

CSF > 8

UA > 10 WBCs

Stool > 5 WBCs/heme

CXR if indicated

Source Identified?

NO

  • Treat Urine if +
  • Check CBC: send Blood Culture if CBC + one dose of Ceftriaxone is MD choice. Conservative Approach

ADMIT

D/C

slide4

Accepted Fever Sources

HSV/Gingivostomatits

Herpangina/Ulcerative Stomatits

RSV

Croup

Flu

Varicella

Viral Exanthum (rash)

Enteroviruscoxsackie HFM dz, echo, rhino, entero,

  • Treatment Doses
  • <28 Days:
  • Acyclovir = 60mg/kg/day divided q 8 hrs
  • Ampicillin = 50mg/kg
  • Gentamicin = dose is age dependent (use less than 8 days)
  • Cefotaxime = 50mg/kg (use if > 8 days)
  • Vacnyomycin = 15-20mg/kg
  • 29 Days – 6mos
  • Ceftriaxone = 50mg/kg