| 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.
|
