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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | | |- |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Age Group
| | | Age Group |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Evaluation
| | | Evaluation |
| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Treatment
| | | Treatment |
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | | | | 0-28d, ≥38C |
| :'''Neonate, 0–28 d* of age, [[Image:]]38°C (100.4°F)'''
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| :SBI incidence of ill appearing: 13%–21%; if not ill appearing: <5%
| | CBC, blood Cx |
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| | UA, Ucx |
| :CBC and blood culture.
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| :''and''
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| :Urinalysis and urine culture.
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| :''and''
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| :CSF cell count, Gram stain, and culture.
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| :Chest x-ray is optional, if no respiratory symptoms.
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| :Stool testing if diarrhea is present.
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| | CSF cell count, GS, Cx |
| :Admit.
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| :''and''
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| :Parenteral antibiotic therapy with ampicillin, 50 milligrams/kg, and cefotaxime, 50 milligrams/kg, or gentamicin, 2.5 milligrams/kg.
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| | CXR (only if resp sx) |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " |
| |
| :'''Infant 29–56 d* of age, [[Image:]]38.2°C (100.8°F) (Philadelphia Protocol)'''
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| :SBI incidence of ill appearing: 13%–21%; if not ill appearing: <5%
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Same as for neonates.
| | Stool testing (if diarrhea present) |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " |
| |
| :Discharge if:
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| :WBC [[Image:]]15,000/mm<sup>3</sup> and [[Image:]]5000/mm<sup>3</sup> and <20% band forms.
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| : Urinalysis negative.
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| : CSF WBC <10 cells/mm<sup>3</sup>.
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| : Negative chest x-ray or fecal leukocytes if applicable.
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| :Admit if any of above criteria are not met and treat with parenteral ceftriaxone, 50 milligrams/kg with normal CSF, 100 milligrams/kg with signs of meningitis.
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " |
| | Admit |
| :'''Infants 57 d* to 6 mo* of age, [[Image:]]38°C (100.4°F)'''
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| :Non-UTI SBI incidence is estimated to be negligible
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| :UTI is 3%–8%
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| | Ampicillin 50mg/kg + (cefotaxime 50mg/kg or gentamicin 2.5mg/kg) |
| :Urinalysis and urine culture alone.
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| :''or''
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| :For conservative management, treat infants 57–90 d using Philadelphia Protocol above.
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| :Discharge if negative.
| | | 29-56d, ≥ 38.2 (100.8) (Philadelphia Protocol) |
| :Treat for UTI with cefixime, 8 milligrams/kg/d daily or divided twice a day, or cefpodoxime, 10 milligrams/kg/d divided twice a day, or cefdinir, 14 milligrams/kg/d divided every 12–24 h for 7–10 d as outpatient.
| | | Same as for neonates |
| :Admit and treat with the parenteral ceftriaxone if fails conservative criteria for discharge. | | | |
| | Discharge if: |
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; "
| | 1. WBC <15K but >5K and <20% bands |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " |
| |
| :'''Infants 57 d to 6 mo* of age [[Image:]]39°C (102.2°F)'''
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| :SBI incidence is estimated <1%; non-UTI SBI incidence is estimated to be negligible.
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| :UTI is 3%–8%
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| | 2. UA negative |
| :Urinalysis and urine culture alone.
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| :''or''
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| :Urinalysis and urine culture in addition to CBC and blood culture.
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| | Admit if above are not met and treat with CTX 50mg/kg if CSF normal, 100mg/kg if signs of meningitis |
| :Discharge if negative.
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| :Treat for UTI as above.
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| :If WBC [[Image:]]15,000/mm<sup>3</sup>, consider treatment with ceftriaxone, 50 milligrams/kg IV/IM, and follow-up in 24 h.
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| :If WBC [[Image:]]20,000/mm<sup>3</sup>, consider chest x-ray and CSF testing<sup>[[Image:]]</sup>.
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | | |- |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | | | | 57d-6mo, ≥38 |
| :'''Infants/children 6–36 mo of age'''
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| :Non-UTI SBI incidence is <0.4%
| | UA and Ucx alone |
| :UTI in girls [[Image:]]8%
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| :UTI in boys (<12 mo) [[Image:]]2%
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| :Uncircumcised boys (1–2 y) remains 2%
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| | OR |
| :Urinalysis and urine culture.
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| : Girls 6–24 mo.
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| : Boys 6–12 mo.
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| : Uncircumcised boys 12–24 mo.
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " |
| | treat 57-90d using Philadelphia Protocol |
| :Discharge if negative.
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| :Treat for UTI as above as outpatient.
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|
| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | | | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | '''Children >36 mo and older'''
| | Discharge if negative |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | No further workup is routinely necessary. | | |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px; " | Discharge and treat with acetaminophen, 15 milligrams/kg PO/PR every 4 h, or ibuprofen, 10 milligrams/kg PO every 6 h as needed. | | Treat UTI w/ cefixime 8mg/kg/d or cefpodoxime 10mg/kg/d divided into BID or cefdinir 14mg/kg/d x 7-10days as outpatient |
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| | Admit and tx with CTX if fail criteria for d/c |
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| | |- |
| | | 57d-6mo, ≥39 (102.2) |
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| | UA and Ucx alone |
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| | OR |
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| | UA and Ucx + CBC + blood cx |
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| | ::Discharge if negative |
| | ::Treat for UTI as above |
| | ::If WBC [[Image:]]15K consider treatment with CTX 50 mg/kg IV/IM, and follow-up in 24hr |
| | ::If WBC [[Image:]]20K consider CXR and CSF |
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| | |- |
| | | 6–36 mo |
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| | UA and Ucx in: |
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| | girls 6-24mo |
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| | boys 6-12mo |
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| | uncirc 12-24mo |
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| | Discharge if negative |
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| | Treat for UTI as above as outpatient |
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| | |- |
| | | >36mo |
| | | No further w/u is routinely necessary |
| | | <br/> |
| |} | | |} |
