Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 12;20(1):117.
doi: 10.1186/s12887-020-2007-4.

Comparing febrile children presenting on and off antibiotics to the emergency department: a retrospective cohort study

R D Sawaya  1 , T El Zahran  1 , S Mrad  1 , C Abdul Massih  1 , S Shaya  2 , M Makki  3 , H Tamim  4 , M Majdalani  5
Affiliations

Comparing febrile children presenting on and off antibiotics to the emergency department: a retrospective cohort study

R D Sawaya et al. BMC Pediatr. .

Abstract

Background: It is not yet known how antibiotics may affect Serious Bacterial Infections (SBI). Our aim is to describe the presentation, management, and serious bacterial infections (SBI) of febrile children on or off antibiotics.

Methods: Retrospective, cohort study of febrile Emergency Department patients, 0-36 months of age, at a single institution, between 2009and 2012.

Results: Seven hundred fifty-three patients were included: 584 in the No-Antibiotics group and 169 (22%) in the Antibiotics group. Age and abnormal lung sounds were predictors for being on antibiotics (OR 2.00 [95% CI 1.23-3.25] and OR 1.04 [95% CI 1.02-1.06] respectively) while female gender, and lower temperatures were negative predictors (OR 0.68 [95%0.47-0.98] and OR 0.47 [95% CI 0.32-0.67] respectively). Antibiotics were prescribed by a physician 89% of the time; the most common one being Amoxicillin/Clavulanic Acid (39%). The antibiotic group got more blood tests (57% vs 45%) and Chest X-Rays (37% vs 25%). Overall, the percent of SBIs (and pneumonias) was statistically the same in both groups (6.5% in the No-antibiotic group VS 3.6%).

Conclusions: Children presenting on antibiotics and off antibiotics were significantly different in their presentation and management, although the overall percentages of SBI were similar in each group. Further investigations into this subgroup of febrile children are needed.

Keywords: Antibiotic use; Febrile children; Serious bacterial infections.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of included patients. * Fever: T (R) ≥ 38, Tax ≥37.6. **Includes Oncologic, Cardiac, Kidney or Liver disease, Inflammatory Bowel Disease, Sickle Cell disease, Insulin Dependent Diabetes Mellitus, Metabolic disease
See this image and copyright information in PMC

References

    1. Rui P, Kang K. National hospital ambulatory medical care survey: 2014 emergency department summary tables. 2014.
    1. Ramgopal S, Janofsky S, Zuckerbraun NS, Ramilo O, Mahajan P, Kuppermann N, et al. Risk of serious bacterial infection in infants aged </=60 days presenting to emergency departments with a history of fever only. J Pediatr. 2019;204:191–195. doi: 10.1016/j.jpeds.2018.08.043. - DOI - PubMed
    1. Craig JC, Williams GJ, Jones M, Codarini M, Macaskill P, Hayen A, et al. The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses. BMJ. 2010;340:c1594. doi: 10.1136/bmj.c1594. - DOI - PMC - PubMed
    1. Baker MD, Bell LM, Avner JR. Outpatient management without antibiotics of fever in selected infants. N Engl J Med. 1993;329(20):1437–1441. doi: 10.1056/NEJM199311113292001. - DOI - PubMed
    1. Baskin MN, O'Rourke EJ, Fleisher GR. Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone. J Pediatr. 1992;120(1):22–27. doi: 10.1016/S0022-3476(05)80591-8. - DOI - PubMed

Substances