Invasive bacterial disease in childhood: efficacy of oral antibiotic therapy following short course parenteral therapy in non-central nervous system infections.

Recommendations vary considerably for duration of parenteral therapy of common bacteremic infections in children. To assess the efficacy of the current standard of practice by private pediatric practitioners in Portland, OR, we reviewed hospital and clinic records of children older than 6 months of age with non-central nervous system bacteremic disease due to Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis and Group A Streptococcus during 1981 to 1984. Diagnoses were: cellulitis (buccal/periorbital), 21; bacteremia without focus, 17; epiglottitis, 13; pneumonia, 7; and other, 4. The average duration (range) of fever (greater than 37.9 degrees C) was 1.8 days (0.5 to 21 days), that of parenteral therapy was 2.9 days (0 to 10 days) and that of oral therapy was 9.5 days (4 to 42 days). No complications of inadequate therapy assessed by clinical or microbiologic failure were reported in study patients. Our review suggests that in a private practice where compliance and accessibility of medical care are good, parenteral therapy for non-central nervous system bacteremic disease need be continued only until the child is afebrile for 24 to 48 hours; outpatient oral therapy should be provided to complete a 10- to 14-day total course of antibiotics. A lumbar puncture should be performed in bacteremic children to rule out occult meningitis.