OUTPATIENT MANAGEMENT WITHOUT ANTIBIOTICS OF FEVER IN SELECTED INFANTS

Background. In many academic centers it is standard practice to hospit alize all febrile infants younger than two months of age, whereas in c ommunity settings such infants are often cared for as outpatients. Met hods. We conducted a controlled study of 747 consecutive infants 29 th rough 56 days of age who had temperatures of at least 38.2-degrees-C. After a complete history taking, physical examination, and sepsis work up, the 460 infants with laboratory or clinical findings suggestive of serious bacterial illness were hospitalized and treated with antibiot ics. The screening criteria for serious bacterial illness included a w hite-cell count of at least 15,000 per cubic millimeter, a spun urine specimen that had 10 or more white cells per high-power field or that was positive on bright-field microscopy, cerebrospinal fluid with a wh ite-cell count of 8 or more per cubic millimeter or a positive Gram's stain, or a chest film showing an infiltrate. The 287 infants who had unremarkable examinations and normal laboratory results were assigned to either inpatient observation without antibiotics (n = 148) or outpa tient care without antibiotics but with reexaminations after 24 and 48 hours (n = 139). Results. Serious bacterial illness was diagnosed in 65 infants (8.7 percent). Of these 65 infants, 64 were identified by o ur screening criteria for inpatient care and antibiotic treatment (sen sitivity = 98 percent; 95 percent confidence interval, 92 to 100). Of the 287 infants assigned to observation and no antibiotics, 286 (99.7 percent) did not have serious bacterial illness. Only two infants assi gned to outpatient observation were subsequently admitted to the hospi tal; neither was found to have a serious illness. Out-patient care wit hout antibiotics of the febrile infants at low risk for serious illnes s resulted in a savings of about $3,100 per patient. Conclusions. With the use of strict screening criteria, a substantial number of febrile one-to-two-month-old infants can be cared for safely as outpatients a nd without antibiotics.