The American College of Emergency Physicians recommends considering antibiotic therapy for previously healthy, well-appearing children ages 3 to 36 months who present with a fever without a clinical source and a WBC count >15,000/mm3.3,14
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In this age of vaccination, the rate of occult bacteremia in febrile children presenting without a source has fallen to 1% or less
The University of Cincinnati Evidence-Based Clinical Practice Guidelines for fever of uncertain source in children ages 2 to 36 months recommends obtaining a CBC for any child who is ill-appearing or at high risk for bacteremia (determined by the clinicians’ judgment). A WBC of ≥15,000/mm3 or ANC >10,000/mm3 provide support for antibiotic therapy.15 The 1993 American Academy of Pediatrics guidelines for fever ≥39°C without a source in children ages 3 months to 3 years recommends a CBC; if the WBC count ≥15,000/mm3, they recommend a blood culture and treatment with antibiotics pending culture results.3,16
It is important to note that in the age of Haemophilus influenza and Streptococcus pneumonia vaccination, the rate of occult bacteremia in febrile children presenting without a source has fallen from 3% to 10% to 1% or less.17 A lower prevalence reduces the utility of routine CBC or blood culture in the evaluation of immunized, febrile children. Parameters such as procalcitonin, interleukin-6, interleukin-8, interleukin-1 receptor antagonist and C-reactive protein show future promise as biochemical markers for identifying serious bacterial infections.18
