Cautionary note on the use of empiric ceftriaxone for suspected bacteremia

Article Abstract:

It is difficult to treat young children with high fevers who do not have an identifiable local infection. The strategy of treating these children with antibiotics, such as intravenous ceftriaxone, because of suspicions of a systemic bacterial infection has begun to pervade medical practice. Two studies of treatment decisions suggest that this strategy is the most cost-effective and beneficial. However, this practice should be viewed with concern and caution. Although occult (hidden) bacteremia (bacteria in the blood) is relatively common in children under three years of age, routine treatment of high fevers of unknown cause with antibiotics may replace careful evaluation of the true cause of the fever. Only one study has addressed the presumptive use of antibiotics; according to the results only modest fever reduction and improvement in symptoms were obtained with presumptive antibiotic therapy. The purpose of such antibiotic therapy has been to prevent meningitis, a very serious complication of bacteremia. Such treatment may prevent the development of meningitis, but would probably not impede an established infection. This possible benefit must be weighed against potential problems, such as serious adverse drug reactions and the increased need to conduct blood tests and follow-up on the presumed bacteremia. Some blood specimens may be falsely reported as positive due to contamination during collection. Trying to culture (grow and identify) bacteria from blood samples is fraught with problems. In the end, routine use of a convenient, powerful, broad-spectrum antibiotic should not replace systematic evaluation of fever in infants, whose treatment may be complicated by such practice. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Editorial, Fever in children, Childhood fever, Ceftriaxone

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Invasive disease due to multiply resistant Streptococcus pneumoniae in a Houston, Tex, day-care center

Article Abstract:

The cases are presented of two toddlers who attended the same day-care facility and were hospitalized for generalized sepsis and, in one of them, meningitis (inflammation of the membranes which surround the brain). In both children the condition was due to a strain of Streptococcus pneumoniae that had developed resistance to several antibiotics, including sulfamethoxazole-timethoprim, oxacillin, tetracycline and penicillin. On the basis of these two index cases, staff, other toddlers who attended the day-care facility, and their family members were tested for the presence of this bacterium. Eighty-six percent of all children attending the facility, and 90 percent of workers and other family members were tested to determine how far the infection had spread. Twenty-nine of 82 children who were cultured were found to have Streptococcus pneumoniae present in the nasopharynx (upper respiratory system). On testing with various antibiotics, 10 of these infections were found to be resistant to antibiotics. Day-care staff and children were treated with the antibiotic rifampin for two days. This treatment resulted in a 70 percent reduction of Streptococcus pneumonia in cultures taken after antibiotic treatment. To the authors' knowledge, this is the first outbreak in the US of S. pneumoniae having substantial resistance to multiple antibiotics. It appears that adults carrying the bacteria are less susceptible to illness from the organism than are children of day-care age. The use of a two-day treatment with rifampin was not able to fully eradicate the bacteria, and could not prevent three additional children and one family member from becoming infected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Streptococcal infections, Drug resistance in microorganisms, Microbial drug resistance, Streptococcus pneumoniae, Rifampin, Houston

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Bacteremia in an ambulatory setting: improved outcome in children treated with antibiotics

Article Abstract:

The clinical characteristics, laboratory findings, and outcomes of 414 children with bacteremia, or bacterial infection of the blood, were assessed. The average age of patients was 21 months. Their bacteremia was due to Haemophilus influenzae in 167 patients and Streptococcus pneumoniae in 247 cases. H. influenzae infections were associated with a greater frequency of infections of the soft tissue, a worse clinical appearance, and increased risk of serious infections, persistent bacteremia, and hospital admissions as compared with S. pneumoniae infections. Patients infected with H. influenzae had a 21.1-fold greater risk of developing meningitis, inflammation of the membranes of the brain and spinal cord, as compared with patients infected with S. pneumoniae. Patients who were able to walk and who were treated with antibiotics were less likely to have new, serious infections of the soft tissue, to have persistent bacteremia, or to require hospitalization as compared with untreated patients. Treatment was more effective in patients with S. pneumoniae infections than in patients with H. influenzae infections. Patients with bacteremia should be carefully followed-up and re-evaluated to detect the development of soft tissue infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Prognosis, Pediatric diseases, Demographic aspects, Infection in children

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