All urine is cathed! All temps are rectal Antibiotics 29 DAYS – 2 MONTHS < 28 DAYS WBC 15 Band/Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR.

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Presentation transcript:

All urine is cathed! All temps are rectal Antibiotics 29 DAYS – 2 MONTHS < 28 DAYS WBC 15 Band/Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR WBC 15 Band/Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR WBC 15 Band/Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR if indicated WBC 15 Band/Neut >0.2 CSF > 8 WBCs UA > 10 WBCs Stool WBCs/heme CXR if indicated Parents Reliable Pediatrician f/u next day Well appearing pt Parents Reliable Pediatrician f/u next day Well appearing pt Anything in w/u + Everything in w/u neg D/C ADMIT * Provider preference: Home with NO antibiotics or first dose Rocephin if LP was preformed; or obs pt for 1 st 24hrs for blood/csf culture neg *

WBC 15 UA > 10 wbc WBC 15 UA > 10 wbc 2 – 3 MONTHS WBC 15 UA - norm WBC 15 UA - norm WBC - wnl UA > 10 wbc WBC - wnl UA > 10 wbc WBC - wnl UA - wnl WBC - wnl UA - wnl Stool > 5 WBCs/heme CBC and UA + or Neg Stool > 5 WBCs/heme CBC and UA + or Neg LP & Blood Cx Parents Reliable Pediatrician f/u Well appearing pt Parents Reliable Pediatrician f/u Well appearing pt OBS and hold antibiotics until stool studies return unless indication to treat blood or urine LP & Blood Cx Ceftriaxone once if Parents Reliable Pediatrician f/u next day Well appearing pt Ceftriaxone once if Parents Reliable Pediatrician f/u next day Well appearing pt Ceftriaxone and strongly consider OBS for blood & CSF cx neg for 24hrs OR Ceftriaxone once and initiate outpatient UTI abx & valve w/u if: Parents Reliable Pediatrician f/u next day Well appearing pt Ceftriaxone once and initiate outpatient UTI abx & valve w/u if: Parents Reliable Pediatrician f/u next day Well appearing pt Ceftriaxone and strongly consider OBS for blood & CSF cx neg for 24hrs OR Discharge with next day follow up and NO antibiotics! *Most PEM providers define FUS > after 2mos

3 – 6 MONTHS Ill Appearing Source Identified? WBC 15 Band/Neut >0.2 CSF > 8 UA > 10 WBCs Stool > 5 WBCs/heme CXR if indicated WBC 15 Band/Neut >0.2 CSF > 8 UA > 10 WBCs Stool > 5 WBCs/heme CXR if indicated Treat Urine if + Check CBC: send Blood Culture if CBC + one dose of Ceftriaxone is MD choice. Conservative Approach Treat Urine if + Check CBC: send Blood Culture if CBC + one dose of Ceftriaxone is MD choice. Conservative Approach UA Treat if + D/C ADMIT YESNO YES NO

Accepted Fever Sources 1.HSV/Gingivostomatits 2.Herpangina/Ulcerative Stomatits 3.RSV 4.Croup 5.Flu 6.Varicella 7.Viral Exanthum (rash) 8.Enterovirus coxsackie HFM dz, echo, rhino, entero, Accepted Fever Sources 1.HSV/Gingivostomatits 2.Herpangina/Ulcerative Stomatits 3.RSV 4.Croup 5.Flu 6.Varicella 7.Viral Exanthum (rash) 8.Enterovirus coxsackie HFM dz, echo, rhino, entero, Treatment Doses <28 Days: Acyclovir = 60mg/kg/day divided q 8 hrs Ampicillin = 50mg/kg Gentamicin = dose is age dependent (use less than 8 days) Cefotaxime = 50mg/kg (use if > 8 days) Vacnyomycin = 15-20mg/kg 29 Days – 6mos Ceftriaxone = 50mg/kg Treatment Doses <28 Days: Acyclovir = 60mg/kg/day divided q 8 hrs Ampicillin = 50mg/kg Gentamicin = dose is age dependent (use less than 8 days) Cefotaxime = 50mg/kg (use if > 8 days) Vacnyomycin = 15-20mg/kg 29 Days – 6mos Ceftriaxone = 50mg/kg