Outpatient management of febrile illness in infants and young chlidren with sickle cell anemia

Abstract

Young children with sickle cell anemia remain at high risk of overwhelming bacterial infection despite the use of prophylactic penicillin therapy and pnuemococcal vaccine. Recognition of the potential for a fulminant course has led to the general recommendation that febrile illness in these children be promptly treated with parenterally administered antibiotics. 1-6 This approach has generally required hospitalization, because frequent intravenously administered doses are needed to maintain adequate blood levels of antibiotics for consistent effectiveness against the most common pathogens, Streptococcus pneumoniae and Haemophilus influenzae type b. We thought that a safe alternative to routine hospitalization may exist for selected patients: cephalosporins, which have a long half-life (allowing onceor twice-daily dosing), provide excellent coverage of the two common organisms. 7-9 For the past 5 years we have used a standardized protocol to guide the initial management of febrile children with sickle cell disease. This protocol mandates prompt evaluation by a physician, complete blood cell count and blood culture, and empiric intravenous administration of a long-acting antibiotic (usually ceftriaxone) before any test results are available or the patient's disposition has been determined. The purpose of this review was to assess the safety, efficacy, and cost-effectiveness of outpatient management according to this protocol.