EFFECT OF ANTIBIOTIC-THERAPY ON THE OUTCOME OF OUTPATIENTS WITH UNSUSPECTED BACTEREMIA

The records of 559 consecutive outpatient children with unsuspected ba cteremia (467 Streptococcus pneumoniae) were reviewed, When compared w ith patients receiving oral or parenteral antibiotics, those patients who received no antibiotics at the initial visit were in follow-up: (1 ) less likely to be improved (32% vs, 86%, P < 0.01); (2) more likely to be febrile (75% vs, 28%, P < 0.01); (3) more likely to be hospitali zed (67% vs, 22%, P < 0.01); (4) more likely to have persistent bacter emia (28% vs, 3%, P < 0.01); and (5) more likely to have new focal inf ections (13% vs, 5%, P < 0.01), Compared with patients receiving paren teral antibiotics at the initial visit, patients receiving oral antibi otics were in follow-up: (1) less likely to be improved (81% vs, 89%, P < 0.05); and (2) more likely to have persistent bacteremia (5% vs, 0 %, P < 0.05), There was no statistical difference between patients rec eiving parenteral or oral therapy in the development of focal infectio ns, although children with new focal infections receiving oral antibio tics more often had persistent or new positive cultures, No patients r eceiving parenteral antibiotics at the initial visit had positive bloo d or spinal fluid cultures at the follow-up visit, Analyses of the sub groups with (1) occult bacteremia with all organisms, (2) unsuspected bacteremia S. pneumoniae and (3) occult bacteremia with S. pneumoniae show results similar to those for the entire group, These findings ext end earlier observations that antibiotic therapy improves the outcome of children with unsuspected bacteremia, particularly with parenteral administration, and point to the continued importance of treatment eve n in the absence of cases caused by Haemophilus influenzae type b.