Document Detail

The need for a second dose of ceftriaxone in febrile infants age 4-8 weeks.
MedLine Citation:
PMID:  10843028     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine if a second intramuscular injection of ceftriaxone was necessary in febrile infants who meet low-risk criteria for outpatient therapy. SETTING: Children's Hospital Emergency Department. PATIENTS: Febrile infants 4-8 weeks of age. METHODS: Outpatient treatment criteria included non-toxic appearance, no identifiable source for infection on physical examination, CSF WBC > or = 10/mm3, peripheral WBC < or = 15,000/mm3, normal UA, and normal chest radiograph study, if obtained. Additional requirements included a reliable caretaker and re-evaluation in 24 hours. Infants who met these criteria received intramuscular ceftriaxone 50 mg/kg with instructions to follow-up in 24 hours. At the follow-up visit, infants with no identifiable source for infection and negative cultures received a second dose of intramuscular ceftriaxone and were discharged. Cultures were read at 48 hours and at the conclusion of the study. Medical records were reviewed to identify delayed complications. RESULTS: 172 infants were enrolled. The mean age was 45 days. All CBC, UA, CSF analyses were normal. Chest radiographs were obtained in 56 (30%) infants; all were normal. One (.05%) patient was admitted at the follow-up visit. The mean time to follow-up was 25 hours. Two positive cultures were identified at the re-evaluation visit; one blood culture grew Salmonella and a urine culture grew E. coli. The CSF cultures were all negative at follow-up and remained negative. CONCLUSION: Febrile infants 4-8 weeks of age who meet outpatient therapy criteria and have negative cultures and no identifiable source for infection at 24 hours may not require the second dose of intramuscular ceftriaxone.
S E Allen; C M Walsh-Kelly; H H Hennes
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  WMJ : official publication of the State Medical Society of Wisconsin     Volume:  99     ISSN:  1098-1861     ISO Abbreviation:  WMJ     Publication Date:  2000 Apr 
Date Detail:
Created Date:  2000-09-05     Completed Date:  2000-09-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9716054     Medline TA:  WMJ     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  60-2     Citation Subset:  IM    
Emergency Medicine Section, Cincinnati Children's Hospital, OH, USA.
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MeSH Terms
Ambulatory Care
Ceftriaxone / administration & dosage*,  therapeutic use
Cephalosporins / administration & dosage*,  therapeutic use
Drug Administration Schedule
Fever / drug therapy*
Infant, Newborn
Injections, Intramuscular
Patient Care Management
Prospective Studies
Reg. No./Substance:
0/Cephalosporins; 73384-59-5/Ceftriaxone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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