OUTPATIENT THERAPY WITH CEFTRIAXONE AND ORAL CEFIXIME FOR SELECTED FEBRILE CHILDREN WITH SICKLE-CELL DISEASE

Purpose: Children with sickle cell disease are at increased risk for b acterial sepsis and, when febrile, are usually hospitalized for intrav enous antibiotic therapy pending results of blood cultures. In this st udy, we prospectively identified a group of febrile patients with sick le cell disease who were at low risk for sepsis and treated them with outpatient therapy. Patients and Methods: Children identified as low r isk for sepsis were treated with an initial dose of intravenous ceftri axone, followed by outpatient therapy with oral cefixime, and were mon itored for 14 days after the initial visit. Compliance was assessed by phone calls to parents and by analysis of urine samples. Results: In 107 eligible febrile episodes (80 patients) over a 21-month period, no patient developed sepsis. One child developed bacteremia 3 days after completing the course of cefixime, and one had splenic sequestration on the fourth study day. Both patients did well. Side effects of cefix ime were modest, and overall compliance was excellent (similar to 95%) , although urine samples were returned by only 56% of parents. Conclus ion: We conclude that outpatient therapy is safe and effective in febr ile patients with sickle cell disease who meet the criteria for a low risk of sepsis.