Bacteremia in ambulatory children.

Bacteremia is a relatively common event in young, apparently mildly ill febrile children. The bacteremia is associated with certain risk factors including age, elevated temperature and high white blood cell count or increased erythrocyte sedimentation rate. The disease and bacteremia clears without antimicrobial agents in some children, but many untreated children have persistent disease. Culture of blood is valuable in children with risk features and may be enhanced in the future as methods for detection of antigen become more widely available. Available data from randomized trials of therapy do not provide clear guidelines for treatment and opinions about optimal management of children at risk for bacteremia vary. My judgement is that presumptive therapy is warranted for the child who is 6 to 24 months of age, who has high fever and has high white blood cell count. Therapy should be effective for the pneumococcus and for H. influenzae. Currently, I recommend amoxicillin or, for children allergic to penicillin, trimethoprim-sulfamethoxazole or cefaclor. After 48 to 72 hours the physician can judge the clinical course and will have data from cultures to base decisions about management of the illness.