Fever Clinical Practice Guideline Update-What’s new in managing fever in children under age 2?

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by Becky Burger, beckyburger@emory.edu

The Children’s Healthcare of Atlanta Clinical Practice Guideline (CPG) on fever in infants and young children was updated in November 2018. The updated guidelines are available on Careforce:  https://choa.careforceconnection.org/docs/DOC-19464

Here are the changes based on age:

For children 0-28 days:

  • The recommended empiric antibiotics are Ampicillin and Gentamicin IV (If there is no IV access, ok to give first dose of both IM)
  • If there is concern for meningitis, give Ampicillin and Ceftazidime (this is for CHOA Emergency Departments only, Urgent Cares do not have Ceftazidime in their pharmacies)
  • If there is suspicion for HSV, it is recommended that HSV PCR be sent from blood, CSF and any suspicious skin lesion. Also nee d to swab eyes, nose & rectum for HSV
  • If patient has diarrhea, send GI PCR panel (GI PCR panel replaces stool culture)

For children 29-60 days:

  • If CRP is obtained, there was consensus on CRP>2 mg/dl as the new cut off for abnormal
  • Urine WBC cut off for abnormal is >9 WBC hpf or Nitrite positive or LES ³2+
  • Preferred antibiotic is still Ceftriaxone, but if there is suspicion for bacterial meningitis add Vancomycin (this is for CHOA Emergency Departments only, Urgent Cares do not have Vancomycin in their pharmacies)

For children 2-6 months:

  • Urine WBC cut off for abnormal is >9 WBC hpf or nitrite positive or LES ³2+; if any one of these abnormal values are present, urinalysis will reflex to urine culture automatically
  • The recommended empiric antibiotic for UTI is Cephalexin 25mg/kg/dose TID x10 days (alternative regimen if concern for compliance with TID dosing is Cefprozil 15mg/kg/dose BID)
  • If there is suspicion for UTI and plan to treat for UTI, ensure that urine culture is ordered (if urinalysis has not already reflexed to culture). As always, urine culture should be from an acceptable specimen (bag specimens not adequate for urine culture)

For children 6-24 months:

  • Same updates as 2-6 months as listed above

If there are any further questions about the Fever CPG 2018 updates, feel free to contact Dr. Becky Burger (beckyburger@emory.edu) or Shabnam Jain (sjain@emory.edu).

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