Daily Bolus of LR: Serious Bacterial Illness 0-28 days

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March 24, 2011 by dailybolusoflr

Serious bacterial illness (SBI)           

 

Age range: 0-28 DAYS

 

Of all age groups, this group is a the highest risk of SBI- about 12%!

 

 

The most common etiologies of fever (temp over 38 C) in this age group are:

Bacteria                                              Virus

Group B Strep                                     HSV (presents between 2-12 days)

Listeria                                                Varicella

E. Coli                                                  Enterovirus

Chlamydia                                           RSV

Gonorrhea                                           Influenza

 

 

 

Evaluation of these children consists of a full sepsis work-up:

·         CBC

·         Blood culture             

·         UA/UCx  (suprapubic tap or catheterization; bagged specimens have over 50% contamination rate)

·         LP

 

 

These children all require empiric antibiotics:

·         AMPICILLIN (100mg/kg/24 hours divided q6h)

Plus

·         GENTAMYCIN (5mg/kg/24 hours divided q8h) or CEFOTAXIME (150mg/kg/24 hours divided q8h)

 

 

Tips:

·         Remember AMPICILLIN for all infants under 1 month, due to need for coverage of Listeria (sepsis/meningitis) and enterococcus (consider strongly if UTI with non-GNR)

·         Consider adding ACYCLOVIR if you suspect HSV (seizures, cutaneous lesions, maternal hx during birth)

·         Lean towards CEFOTAXIME if you suspect meningitis

·         Consider VANCOMYCIN if you are very concerned about MRSA or Streptococcus pneumoniae meningitis

 

DISPOSITION: ADMIT

 

 

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

 

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