TY - JOUR
T1 - Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia
AU - Fleisher, Gary R.
AU - Rosenberg, Norman
AU - Vinci, Robert
AU - Steinberg, Joel
AU - Powell, Keith
AU - Christy, Cynthia
AU - Boenning, Douglas A.
AU - Overturf, Gary
AU - Jaffe, David
AU - Platt, Richard
N1 - Funding Information:
Supported in part by a grant from Hoffmann-LaRoche. Submitted for publication April 19, 1993; accepted Nov. 8, 1993 Reprint requests: Gary R. Fleisher, MD, Children's Hospital, 300 Longwood Ave., Boston, MA 02115. Copyright | 1994 by Mosby-Year Book, Inc. 0022-3476/94/$3.00 + 0 9/20/52687 Bacteremia with pathogenic microorganisms occurs in 3% to 7% of young children with high fever and no apparent source of serious infection, 19 and may lead to focal sequelae, sepsis, and/or death. 1~ The optimal treatment for children with known or suspected occult bacteremia has not been established. 1~ Despite this uncertainty, some
PY - 1994/4
Y1 - 1994/4
N2 - Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature ≥39° C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08,to 1.82, p=0.31). The five children with definite bacterial infections (three meningitls, one pneumonia, one sepsis) recelved amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p=0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p=0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever.
AB - Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature ≥39° C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08,to 1.82, p=0.31). The five children with definite bacterial infections (three meningitls, one pneumonia, one sepsis) recelved amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p=0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p=0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever.
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U2 - 10.1016/S0022-3476(05)83126-9
DO - 10.1016/S0022-3476(05)83126-9
M3 - Article
C2 - 8151462
AN - SCOPUS:0028355111
SN - 0022-3476
VL - 124
SP - 504
EP - 512
JO - The Journal of pediatrics
JF - The Journal of pediatrics
IS - 4
ER -