Pediatric fever of uncertain source

Age Group	Evaluation	Treatment
Neonate, 0–28 d* of age, [[Image:]]38°C (100.4°F) SBI incidence of ill appearing: 13%–21%; if not ill appearing: <5%	CBC and blood culture. and Urinalysis and urine culture. and CSF cell count, Gram stain, and culture. Chest x-ray is optional, if no respiratory symptoms. Stool testing if diarrhea is present.	Admit. and Parenteral antibiotic therapy with ampicillin, 50 milligrams/kg, and cefotaxime, 50 milligrams/kg, or gentamicin, 2.5 milligrams/kg.
Infant 29–56 d* of age, [[Image:]]38.2°C (100.8°F) (Philadelphia Protocol) SBI incidence of ill appearing: 13%–21%; if not ill appearing: <5%	Same as for neonates.	Discharge if: WBC [[Image:]]15,000/mm3 and [[Image:]]5000/mm3 and <20% band forms.     Urinalysis negative.     CSF WBC <10 cells/mm3.     Negative chest x-ray or fecal leukocytes if applicable. Admit if any of above criteria are not met and treat with parenteral ceftriaxone, 50 milligrams/kg with normal CSF, 100 milligrams/kg with signs of meningitis.
Infants 57 d* to 6 mo* of age, [[Image:]]38°C (100.4°F) Non-UTI SBI incidence is estimated to be negligible UTI is 3%–8%	Urinalysis and urine culture alone. or For conservative management, treat infants 57–90 d using Philadelphia Protocol above.	Discharge if negative. Treat for UTI with cefixime, 8 milligrams/kg/d daily or divided twice a day, or cefpodoxime, 10 milligrams/kg/d divided twice a day, or cefdinir, 14 milligrams/kg/d divided every 12–24 h for 7–10 d as outpatient. Admit and treat with the parenteral ceftriaxone if fails conservative criteria for discharge.
Infants 57 d to 6 mo* of age [[Image:]]39°C (102.2°F) SBI incidence is estimated <1%; non-UTI SBI incidence is estimated to be negligible. UTI is 3%–8%	Urinalysis and urine culture alone. or Urinalysis and urine culture in addition to CBC and blood culture.	Discharge if negative. Treat for UTI as above. If WBC [[Image:]]15,000/mm3, consider treatment with ceftriaxone, 50 milligrams/kg IV/IM, and follow-up in 24 h. If WBC [[Image:]]20,000/mm3, consider chest x-ray and CSF testing[[Image:]].
Infants/children 6–36 mo of age Non-UTI SBI incidence is <0.4% UTI in girls [[Image:]]8% UTI in boys (<12 mo) [[Image:]]2% Uncircumcised boys (1–2 y) remains 2%	Urinalysis and urine culture.     Girls 6–24 mo.     Boys 6–12 mo.     Uncircumcised boys 12–24 mo.	Discharge if negative. Treat for UTI as above as outpatient.
Children >36 mo and older	No further workup is routinely necessary.	Discharge and treat with acetaminophen, 15 milligrams/kg PO/PR every 4 h, or ibuprofen, 10 milligrams/kg PO every 6 h as needed.