Pediatric fever of uncertain source

Management of patients who are Well-Appearing, vaccinated, and no clinical source of fever

Age Group	Evaluation	Treatment
0-28d, ≥38C	CBC, blood Cx UA, Ucx CSF cell count, GS, Cx CXR (only if resp sx) Stool testing (if diarrhea present)	Admit Ampicillin 50mg/kg + (cefotaxime 50mg/kg or gentamicin 2.5mg/kg)
29-56d, ≥ 38.2 (100.8) (Philadelphia Protocol)	Same as for neonates	Discharge if: 1. WBC <15K but >5K and <20% bands 2. UA negative Admit if above are not met and treat with CTX 50mg/kg if CSF normal, 100mg/kg if signs of meningitis
57d-6mo, ≥38	UA and Ucx alone OR treat 57-90d using Philadelphia Protocol	Discharge if negative Treat UTI w/ cefixime 8mg/kg/d or cefpodoxime 10mg/kg/d divided into BID or cefdinir 14mg/kg/d x 7-10days as outpatient Admit and tx with CTX if fail criteria for d/c
57d-6mo, ≥39 (102.2)	UA and Ucx alone OR UA and Ucx + CBC + blood cx	Discharge if negative Treat for UTI as above If WBC>15K consider treatment with CTX 50 mg/kg IV/IM, and follow-up in 24hr If WBC>20K consider CXR and CSF
6–36 mo	UA and Ucx in: girls 6-24mo boys 6-12mo uncirc 12-24mo	Discharge if negative Treat for UTI as above as outpatient
>36mo	No further w/u is routinely necessary