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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
USA
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:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html