INTRAMUSCULAR VERSUS ORAL ANTIBIOTIC-THERAPY FOR THE PREVENTION OF MENINGITIS AND OTHER BACTERIAL SEQUELAE IN YOUNG, FEBRILE CHILDREN AT RISK FOR OCCULT BACTEREMIA

Because studies of the treatment of children with occult bacteremia ha ve yielded conflicting results, we compared ceftriaxone with amoxicill in for therapy. Inclusion criteria were age 3 to 36 months, temperatur e greater than or equal to 39 degrees C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for si x doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were ev aluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b , 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatmen t, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two f rom the spinal fluid (two H. influenzae type b), compared with none gi ven ceftriaxone. Probable or definite infections occurred in three chi ldren treated with ceftriaxone and six given amoxicillin (adjusted odd s ratio 0.43, 95% confidence interval 0.08 to 1.82, p = 0.31). The fiv e children with definite bacterial infections (three meningitis, one p neumonia, one sepsis) received amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p = 0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence inter val 0.28 to 0.94, p = 0.04). Although the difference in total infectio ns was not significant, ceftriaxone eradicated bacteremia, prevented s ignificantly more definite focal bacterial complications, and was asso ciated with less persistent fever.