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Antibiotic administration to treat possible occult bacteremia in febrile children
D M Jaffe1, R R Tanz, A T Davis
1Division of General and Emergency Pediatrics, Children's Memorial Hospital, Chicago, IL 60614.
Insights
Routine antibiotic use in febrile children without focal infection is not supported. A clinical trial found amoxicillin did not reduce infectious morbidity in children with occult bacteremia, though it did reduce fever.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
Background:
- Occult bacteremia in febrile children presents a diagnostic challenge.
- Antibiotic treatment for occult bacteremia is debated due to potential risks and benefits.
Purpose of the Study:
- To evaluate the efficacy of oral amoxicillin in treating possible occult bacteremia in febrile children.
- To assess the impact of antibiotics on infectious morbidity and clinical outcomes.
Main Methods:
- Prospective, randomized, placebo-controlled, double-blind clinical trial.
- 955 febrile children (3-36 months) without focal infection received amoxicillin or placebo.
- Blood cultures and clinical assessments were performed.
Main Results:
- 2.8% of randomly assigned children had bacteremic infections.
- No significant difference in major infectious morbidity between amoxicillin and placebo groups.
- Amoxicillin reduced fever and improved clinical appearance in bacteremic children, but not non-bacteremic ones.
Conclusions:
- Data do not support routine amoxicillin use in febrile children without evidence of focal bacterial disease.
- Antibiotics did not alter the incidence of major infectious morbidity in this cohort.
Abstract:
We performed a prospective, randomized, placebo-controlled, double-blind clinical trial of antibiotic administration to treat possible occult bacteremia in febrile children. A total of 955 children aged 3 to 36 months with temperatures greater than or equal to 39.0 degrees C and no focal bacterial infection were enrolled at the emergency departments of two children's hospitals from January 1982 until July 1984. Blood samples for culture were obtained, and the children were randomly assigned to receive either oral amoxicillin or placebo and were restudied approximately 48 hours after enrollment. Data were also collected on 228 children who could not be randomly assigned. Twenty-seven of the randomly assigned children (2.8 percent) had bacteremic infections with pathogenic organisms (Streptococcus pneumoniae, Haemophilus influenzae, and salmonella). There were no differences in the incidence of major infectious morbidity associated with bacteremia between the antibiotic and placebo groups--2 of 19 patients (10.5 percent) in the antibiotic group and 1 of 8 (12.5 percent) in the placebo group--although the power for this comparison was low. Antibiotics reduced fever (P less than 0.005) and improved the clinical appearance (P = 0.07) in the children with bacteremia but not in those without bacteremia. Although there were no statistically significant differences in the incidence of side effects, diarrhea tended to occur more often in the patients treated with amoxicillin (15 vs. 11 percent, P less than 0.10). We conclude that our data do not support the routine use of standard oral doses of amoxicillin in febrile children who do not have evidence of focal bacterial disease.