A5V4d

GDG translation
Management by the non-paediatric practitioner
The GDG felt that in the presence of clinical signs of pneumonia or bronchiolitis, a chest X-ray is of no
added diagnostic benefit in ambulatory care.
Recommendations
Number Recommendation
Chest X-rays
43 Children with symptoms and signs suggesting pneumonia who are not admitted to
hospital should not routinely have a chest X-ray. [2007]
Urinalysis
In children with fever, urine should be tested for infection as described in Urinary Tract Infection in
Children. *
Recommendations
Number Recommendation
44 Test urine in children with fever as recommended in ‘Urinary tract infection in
children’ (NICE clinical guideline 54). [2007, amended 2013]
7.4 Use of antibiotics by the non-paediatric practitioner
There are two situations in which a GP or prescribing professional may want to give antibiotics to a
child with fever in the absence of a firm diagnosis of a bacterial infection. These are, firstly, in a child
who is not particularly unwell and where the focus of infection cannot be found or initially established,
and, secondly, in a very unwell child where the prescribing professional wants to prevent deterioration
before transfer to hospital. This guideline relates to fever in children in both circumstances. Antibiotics
have sometimes been prescribed empirically in this situation. The rationale behind this is sometimes
put that these antibiotics might treat an unapparent bacterial infection or prevent development of
severe bacterial infection (SBI). The temptation for a healthcare professional to recommend
antibiotics may be increased by parental expectations and pressure. However, inappropriate
prescribing of antibiotics is a major cause of antibiotic resistance. Antibiotics also have adverse
effects, commonly rash and diarrhoea but also severe reactions such as allergy, anaphylaxis and
Stevens–Johnson syndrome.
The use of antibiotics in children without a specific bacterial infection is thus not regarded as good
clinical practice except when meningococcal disease is suspected, where immediate parenteral
benzylpenicillin is currently recommended. 154
Oral antibiotics
Review question
What are the benefits and risks of giving oral antibiotics to febrile children with no known focus of
infection and no symptoms or signs of serious illness?
Narrative evidence
Three studies were found that evaluated antibiotics in children with no major focus of infection and
who were well appearing. Two were EL 2+ SRs comprising eleven and four papers, respectively. 155,156
They examined the effect of oral and parenteral antibiotics in preventing SBI in well-appearing
* See Urinary tract infection in children, NICE clinical guideline 54 (2007)
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