Unsuspected bacteremia due to Haemophilus influenzae: outcome in children not initially admitted to hospital.

Children not initially admitted to the hospital accounted for 42 of 94 episodes of bacteremia due to Haemophilus influenzae. Antibiotics were prescribed for 22 of the 42 children who were initially sent home; at second visit, 17 were improved, including all 13 with pneumonia. No antibiotics were prescribed for 20 children; at second visit, 15 had persistent fever or new focal infection and five had resolution of symptoms. New diagnoses of focal infection were made at second visit in three of the 22 treated and in 11 of the 20 untreated children, including three who had a new diagnosis of meningitis (one treated with antibiotics initially; two not treated). Cultures of blood positive for H. influenzae were obtained at second visit in ten children who were not treated initially; no child who was treated initially had a second positive culture. These findings indicate that although young children with bacteremia due to H. influenzae may be mildly ill at first visit, many are at risk for development of serious focal infection, including meningitis.