Low risk

[Pediatrics 2010;125:228-33]

 

- Recommend:

  • CBC

  • CRP

  • blood cultures

  • catheter/suprapubic urine.

Lumber puncture (LP) should be considered in infants with sepsis without a focus.

- Watchful waiting with no empiric antibiotic therapy may be considered for low risk infants if ALL of the following criteria are met:

  • previously healthy – term, uncomplicated perinatal course, no chronic illness or surgery, no prior antibiotics

  • no focal bacterial infection on exam (including no otitis media)

  • non-toxic – no lethargy, good perfusion, normal respiratory rate, no cyanosis, feeding well

  • negative laboratory screen – WBC 5-15 x 109/L, CRP < 20mg/L, urinalysis < 10 WBC/hpf

  • parents are reliable and close follow-up is assured.

Usual Pathogens

Group B Streptococci
E. coli
S. pneumoniae
N. meningitidis

 
Occasionally:

H. influenzae

 

Empiric Therapy Dose Duration
Cefotaxime 200mg/kg/d IV div q6h Reassess at 48h with culture results.