Fever Without A Clinical Source v1

  • 0 – 28 days T > 38
    • Child looks well or toxic
      • Workup
        • CBC
        • LJA, g/s, Ucx
        • Blood Cx
        • LP – CSF
        • CXR
        • +/- School studies
      • Treament
        • Ampicillin 50-100 mg/kg & Gentamicin 5 mg/kg and/or Cefotaxime 50-100 mg/kg
        • (Acyclovir 20mg/kg if CSF+)
      • Dispoisiton & Follow-Up
        • Admit
  • 28 – 89 days T > 38
    • Child looks toxic
      • Workup
        • CBC, BCx
        • UA, g/s, UCx
        • LP – CSF
        • CXR
        • +/- School studies
      • Treatment
        • Cefotaxime 50-100 mg/kg & Consider Ampicillin 50-100 mg/kg
        • (Acyclovir 20 mg/kg if CSF+)
        • (Vancomycin 15 mg/kg if CSF+)
      • Disposition & Follow-Up
        • Admit
    • Child looks well
      • Workup
        • UA, g/s, Ucx
        • CBC, BCx
        • +/- LP – CSF
        • CXR
      • Treatment
        • +/- Ceftriaxone 50-100 mg/kg
      • Dispoistion & Follow-Up
        • Workup (+) or High RIsk: Admit
        • Workup (-): Home with 24 hour follow-up
  • 90 d – 36 mo T > 39 3-24 mo or T > 39.5 for 24-36 mo
    • Child looks toxic
      • Workup
        • CBC, BCx
        • UA, g/s, UCx
        • LP – CSR
        • CXR
      • Treatment
        • Ceftriaxone 50-100 mg/kg
        • (Vancomycin 25 mg/kg if CSF+)
      • Disposition & Follow-Up
        • Admit
    • Child looks well and has Prevnar
      • Workup
        • UA, g/s, UCx
        • +/- CXR
      • Treatment
        • Oral Abx if indicated
      • Disposition & Follow-Up
        • Home with 48 hour follow-up or RTER if worsening sx
    • Child looks well and no Prevnar
      • Workup
        • UA, g/s, UCx
        • CBC, BCx
        • +/- CXR
      • Treatment
        • If WBC > 15k:
          • Ceftriaxone 50-100 mg/kg
          • Consider LP, osp in < 6mo old
      • Disposition & Follow-Up
        • Home with 24 hour follow-up
  • 3-36 months T 38-38.9
    • Child looks well
      • Workup
        • +/- UA, g/s, Ucx
        • +/- CXR
      • Treatment
        • Oral abx if indicated
      • Disposition & Follow-Up
        • Home with 48-72 hour follow-up

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