Outpatient management of fever in children with sickle cell disease (SCD) in an African setting

Because hospitalization and intravenous antibiotics for treatment of a pote ntially fatal bacterial infection in febrile children with sickle cell dise ase (SCD) are difficult to apply, outpatient treatment has been considered in developed countries for selected patients, Eligibility criteria and proc edures may differ in developing countries because of unique economic and so cial conditions, After clinical evaluation within 36 hr of the onset of a f ever exceeding 38.5 degrees C, children with SCD who are being closely foll owed as a part of a SCD cohort in Cotonou (West Africa), were treated as ou tpatients. The antibiotic regimen consisted of intramuscular injection of c eftriaxone 50 mg/kg/day for 2 days followed by amoxicillin 25 mg/kg x 3/day x 4 days and oral hyper-hydration. Patients were observed for 6 hr and the reafter discharged with a medical control at day 2, day 8 + day 15, All 60 children included completed their treatment, and none were lost to follow-u p. A definite or a presumed bacterial infection was the cause of the febril e episode in 76.7% of cases. An appreciable decrease in fever was observed from day 2 and only 2 patients were hospitalized at day 3, one for abdomina l painful crisis and one other for persistent fever without documented infe ction, No severe bacterial infections, recurrence of febrile episode, nor d eath were encountered during the follow-up, The cost of this outpatient app roach is US $30 per patient as compared to US $140 per patient if the patie nt had been hospitalized, Outpatient management of febrile episode in child ren with SCD is feasible and cost-effective in Sub-Saharan African. It requ ires, however, improved medical education on SCD and immediate medical atte ntion after the onset of fever. Am. J, Hematol, 62:1-6, 1999, (C) 1949 Wile y-Liss, Inc.