I saw one of these yesterday. 3 yo with fever for 4 days. only
complaint was mild abd pain. seen 3d b4 and other doc got cbc, chem
7, and urine. exam was b9. wbc=24k. urine with +trace nitrate and 4
wbc/hpf. sent home with no abx. came back the day b4 i saw her, and
repeated wbc=12 and got strep screen altho throat exam said normal and
it was + (although also + in oct). started on amox. came back
yesterday and i saw her. extremely adorable and pleasant and playful
active who"kept mom up all not" treating the fever. the temp was
102.9. all ohter vitals normal. urine now groing staph aureus 25-50k
that is mssa. was a cath spec. repeat urine with 4wbc and +nit. I
switched to keflex and gave shot of rocephin.
Any critique of me (or others- i would critique others).
On Dec 19, 2007, at 6:29 AM, Peter Auerbach wrote:
> Not to be facetious, but you are describing the majority of the
> patients I see every day.
> Febrile, "not unwell", started on antibiotics by PCP, continues to
> have fever (despite the antibiotics!), "looks well in the ED" with
> "no focus of infection".
> In a child over the age of two, who has been fully vaccinated and
> appears to be well,
> I would do no tests (a urine only if urinary symptoms, history of
> UTI or suspicion of UTI on the part of the parents)
> and reassure the parents as to the likely viral and self-limited
> nature of the infection.
> (And if they asked me if they should continue the antibiotics, I
> would say that I saw no reason why they should.)
> I would only worry about meningitis (partially-treated or otherwise)
> if the child had acted meningitic at some point
> (e.g. c/o HA, vomiting, neck stiffness, etc.).
> I am curious as to why this case was a cause of concern?
> Did something bad or unusual happen to the child?
> Peter Auerbach
> Inova Fairfax Hospital for Children
> Falls Church, VA
> P.S. I do worry about "partially-treated meningitis" in very young
> children (e.g. under 3 months) with fever without a source who have
> been on antibiotics already and are getting worse or acting fussy or
> vomiting, or in somewhat older infants (up to a year?) with fever
> who are on antibiotics and have had a seizure, but not in well-
> appearing older children who never had symptoms suggestive of
> meningitis at any point during their illness.
>> Date: Wed, 19 Dec 2007 15:10:44 +1100> From: [log in to unmask]>
>> Subject: fever and antibiotics> To: [log in to unmask]> >
>> A case which has caused concern for us in Australia:> > 2yo girl
>> onset of illness 5 days ago. Initially saw primary care > physician
>> 4 days ago with History of 1 day of fever. Commenced on > oral
>> amoxicillin, was not unwell at that time. Now 4 days after >
>> commencing antibiotics she presents to our ED with ongoing fevers
>> to > 39.5 C. She has remained well but not quite her usual self,
>> and looks > well in the ED, no focus of infection.> > What workup
>> will you do? When do we need to exclude partially > treated
>> meningitis/bacterial illness? What symptoms or signs are > reliable
>> in this setting> > We would appreciate the collective knowledge of
>> the list as the > literature does not seem to help> > Thanks> Ed> >
>> Ed Oakley> Paediatric Emergency Physician> Department of Emergency
>> Medicine> Royal Children's Hospital,> Flemington Rd> Parkville
>> Victoria 3052> Australia> > Tel: +61 3 9345-6592> Fax: +61 3
>> 9345-5938> email: [log in to unmask]> > > For more information,
>> send mail to [log in to unmask] with the message: info PED-
>> EM-L> The URL for the PED-EM-L Web Page is:> http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
> For more information, send mail to [log in to unmask] with
> the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
Donald Zweig MD
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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