Document Detail

Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Health Care Policy and Research.
MedLine Citation:
PMID:  8517575     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVE: To develop guidelines for the care of infants and children from birth to 36 months of age with fever without source. PARTICIPANTS AND SETTING: An expert panel of senior academic faculty with expertise in pediatrics and infectious diseases or emergency medicine. DESIGN AND INTERVENTION: A comprehensive literature search was used to identify all publications pertinent to the management of the febrile child. When appropriate, meta-analysis was used to combine the results of multiple studies. One or more specific management strategies were proposed for each of the decision nodes in draft management algorithms. The draft algorithms, selected publications, and the meta-analyses were provided to the panel, which determined the final guidelines using the modified Delphi technique. RESULTS: All toxic-appearing infants and children and all febrile infants less than 28 days of age should be hospitalized for parenteral antibiotic therapy. Febrile infants 28 to 90 days of age defined at low risk by specific clinical and laboratory criteria may be managed as outpatients if close follow-up is assured. Older children with fever less than 39.0 C without source need no laboratory tests or antibiotics. Children 3 to 36 months of age with fever of 39.0 C or more and whose WBC count is 15,000/mm3 or more should have a blood culture and be treated with antibiotics pending culture results. Urine cultures should be obtained from all boys 6 months of age or less and all girls 2 years of age or less who are treated with antibiotics. CONCLUSION: These guidelines do not eliminate all risk or strictly confine antibiotic treatment to children likely to have occult bacteremia. Physicians may individualize therapy based on clinical circumstances or adopt a variation of these guidelines based on a different interpretation of the evidence.
L J Baraff; J W Bass; G R Fleisher; J O Klein; G H McCracken; K R Powell; D L Schriger
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Publication Detail:
Type:  Guideline; Journal Article; Meta-Analysis; Practice Guideline; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  22     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  1993 Jul 
Date Detail:
Created Date:  1993-07-21     Completed Date:  1993-07-21     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1198-210     Citation Subset:  AIM; IM    
UCLA Emergency Medicine Center.
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MeSH Terms
Child, Preschool
Fever of Unknown Origin / etiology,  therapy*
Infant, Newborn
Grant Support
R18 HS 06284/HS/AHRQ HHS
Comment In:
Ann Emerg Med. 1994 Mar;23(3):598-600   [PMID:  8135443 ]
Ann Emerg Med. 1993 Jul;22(7):1196-7   [PMID:  8517574 ]
Erratum In:
Ann Emerg Med 1993 Sep;22(9):1490

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