THE USE OF ANTIBIOTICS TO PREVENT SERIOUS SEQUELAE IN CHILDREN AT RISK FOR OCCULT BACTEREMIA - A METAANALYSIS

Objective: To determine whether antibiotics prevent serious bacterial infections in children at risk for occult bacteremia. Methods: Meta-an alysis of randomized controlled trials involving children aged 3 month s to 36 months without a focus of infection and randomized into 2 trea tment groups: 1) no antibiotic vs antibiotic or 2) IM ceftriaxone vs o ral antibiotic. Results: The use of either an oral antibiotic or IM ce ftriaxone did trend toward a reduced risk of serious infection, althou gh neither reached statistical significance (OR = 0.60; 95% CI 0.10, 3 .49; and OR = 0.38; 95% CI 0.12, 1.17, respectively). It would be nece ssary to treat 414 patients to prevent 1 serious bacterial infection. When only children with proven occult bacteremia were analyzed, the us e of IM ceftriaxone was statistically significant in preventing seriou s bacterial infections (OR = 0.25; 95% CI 0.07, 0.89). Conclusions: Cl inical judgment should not be replaced by widespread antibiotic use in the approach to a child with fever. If rapid methods to identify chil dren with occult bacteremia, such as polymerase chain reaction, could be improved and become widely available, then antibiotics could be use d judiciously on initial visits. Antibiotic use in all children at ris k for occult bacteremia implies the treatment of many children unlikel y to benefit from such therapy.