Question

• In patients with sickle cell disease younger than 5 years of age, is outpatient management of fever comparable to inpatient management of fever for prevention of overwhelming bacterial sepsis?

Clinical Bottom Lines

1. It is preferable to treat all febrile sickle cell patients younger than 5 years of age with IV antibiotics until blood cultures are negative for at least 48 hours to prevent overwhelming bacterial sepsis.

Summary of Key Evidence

1. In 1996 study of 107 episodes (80 children) of fever among children ages 6 mos-18 years treated with oral antibiotics, authors concluded that outpatient treatment is as efficacious as parenteral therapy.¹
2. However, all 11 of the children who were subsequently admitted to the hospital due to significant illness (although none with overwhelming sepsis) despite oral therapy were younger than 5 years of age.

Additional Comments

• Study is problematic due to problems with confounding variables and generalizability.
• The confounding variable is the number of febrile episodes (107) is less than the total number of children in the study (80).
• The study has problems with generalizability given that the study involves a very specific patient population that is followed very closely through St. Jude's research hospital and the fact that in addition to stated exclusion criteria, study also excluded children that met "high risk" criteria that were never defined.
  

Citation

1. Williams et al. Outpatient treatment with ceftriaxone and oral cefixime of selected febrile children with sickle cell disease. J Pediatric Hematology Oncology 1996;18:256-261.

CAT Author: Sara Boblick, MD

CAT Appraisers: James Gurney, PhD

Date appraised: March 29, 2006