Age

Qual ifications

Physical Examination

Lab values to determine

low-risk stratification

Treatment for High risk

patients

Treatment for Low risk

patients

Study outcome statistics

Rochester Criteria

<60 days

Term infant

No perinatal antibiotics

No underlying disease

Not hospitalized longer than the

mother at birth

Well-appearing

No ear, soft tissue, or bone infection

WBC >5,000 and <15,000/�L

Absolute band count <1,500/�L

UA <10 WBC/HPF

Hospital admission

Empiric antibiotics

Home

No antibiotics

Follow-up required

Sensitivity 92%

Specificity 50%

PPV 1 2.3%

NPV 98.9%

Philadelphia Protocol

29-60 days

Not specified

Well-appearing

Unremarkable exam

WBC <15,000/�L

Band-neutrophil ratio <0.2

UA <1 0 WBC/HPF

Urine Gram stain negative

CSF <8 WBC/�L

CSF Gram stain negative

Chest radiograph: no infi ltrate (if done)

Hospital admission

Empiric antibiotics

Home

No antibiotics

Follow-up required

Sensitivity 98%

Specificity 42%

PPV 1 4%

NPV 99.7%

Boston Criteria

28-89 days

No immunizations within

preceding 48 hours

No antimicrobial within 48 hours

Not dehydrated

Well-appearing

No ear, soft tissue, or bone infection

WBC <20,000/�L

CSF <10/�L

UA <1 0 WBC/HPF

Chest radiograph: no infiltrate

(if done)

Hospital admission

Empiric antibiotics

Home

Empiric antibiotics

Follow-up required

Sensitivity-NA

Specificity 94.6%

PPV-NA

NPV-NA

CSF, Cerebrospina l Flu id; HPF, high-power field; NA, not available; N PV, negative predictive va lue; PPV, positive predictive va lue; UA, urinaly ­

sis; WBC, white blood cel ls.

supportive care with no additional laboratory studies or

antibiotic therapy is appropriate.

Toxic-appearing febrile infants and children, regardless of age, require a full septic work-up, broad-spectrum

antibiotics, and admission. Fever in immunocompromised

children should also be aggressively managed as outlined

previously followed by prompt communication with their

subspecialty providers. Antibiotics should never be delayed

to complete a septic evaluation.

TREATMENT

Fever may be treated with an antipyretic such as

acetaminophen ( 10-15 mglkg) every 4 hours or ibuprofen

(5-10 mg/kg) every 6 hours as needed to ensure patient comfort. It is important to note that correlation between defervescence with an antipyretic and incidence of SBI has not

been established and should not affect clinical decision making. Ample fluid intake should be encouraged. Some patients

may require intravenous fluids if dehydration is present.

Patients with an identifiable focus of infection should be

treated with the most appropriate antibiotic regimen. For

fever without a source, empiric antibiotics may be given,

based largely on the patient's age and r isk stratification.

Infants who are <1 month of age should be treated

with antibiotic therapy directed at the most common

pathogens causing SBI in this age group (Listeria,

Escherichia coli, Group B Strep, and other gram-negative

organisms).