I also thought it was a "trick-question"....
agree with Peter...not much to be done except UrCx and perhaps CXR...in
case of atypical pneumonia you're not covering with Amox.
Quoting Peter Auerbach <[log in to unmask]>:
> 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:>
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