Pediatric Guidelines: Fever Without a Source - Young Infant

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Definition of Fever Without a Source: Any temperature >=38.0 C/100.4 F in infant from age groups below.

Blood, urine and CSF cultures are recommended before antibiotic administration.

Modification of therapy is indicated if a focal source is identified or suspected:

  • Refer to Severe Sepsis section for infants who meet criteria for severe sepsis. 
  • Refer to Meningitis section if meningitis is suspected. 
  • Refer to Herpes Simplex Virus section if neonatal HSV is suspected. 
  • Conventional antibiotics used for fever without a source do not provide sufficient activity for common skin flora - additional Gram positive coverage is needed if signs of skin/soft tissue infection are present. 
  • Consult ID for suspected bone or joint infection.  
Condition Major Pathogens First Choice Therapy Alternative Therapy Comments

Fever without a source 

< 28 days old, community-onset, previously healthy (admitted from home)

Enteric Gram negatives

Group B streptococcus

Less Common:

Staphylococcus aureus

Listeria monocytogenes

Herpes simplex virus

Ampicillin 

AND

Gentamicin

Acyclovir should not be routinely added based on fever alone - refer to Herpes Simplex Virus section for indications

Cefotaxime in place of Ampicillin and Gentamicin

Refer to Neonatal Dosing Guideline for antibiotic doses and intervals

Therapy should not be broadened based on ongoing fever alone. Many infections in this age group are viral. Consider evaluation and testing for viral infection based on clinical presentation.

Fever without a source

28-90 days old, community-onset, previously healthy (presenting from home)

Streptococcus pneumoniae

Enteric Gram negatives

Group B streptococcus

Neisseria meningitidis

If infant meets Low-Risk crtieria (well-appearing, no apparent focal infection, WBC 5,000-15,000 cells/mm3, band count <=1500 cells/mm3, urine WBC <=5/HPF), antibiotic treatment is not indicated

Corrected gestational age <44 weeks:

Use Cefotaxime per Neonatal Dosing Guideline in place of Ceftriaxone

Therapy should not be broadened based on ongoing fever alone. Many infections in this age group are viral. Consider evaluation and testing for viral infection based on clinical presentation.

If infant does not meet Low-Risk criteria:

Ceftriaxone 50mg/kg/dose IV q24h

Acyclovir should not be routinely added based on fever alone - refer to Herpes Simplex Virus section for indications

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).