A5V4d

Feverish illness in children
Antibiotics
Narrative evidence
One EL 2- cohort study 196 which evaluated the effect of empirical antibiotics on the outcome of SBI
was found.
The prospective cohort study of critically ill adults 196 studied the relationship between inadequate
antimicrobial treatment of infections (community-acquired and hospital-acquired) and hospital
mortality for patients requiring ICU admission. The mortality rate of infected patients receiving
inadequate antimicrobial treatment (52%) was significantly greater than the hospital mortality rate of
patients without this risk factor (12%) (RR 4.26, 95% CI 3.52 to 5.15, P < 0.001).
Evidence summary
Critically ill children with SBI who are given no or ineffective antibiotics have an increased risk of
mortality.
GDG translation
A diagnosis of SBI (especially bacteraemia) may not be confirmed until 12–36 hours from time of
culture, since it takes this period of time to grow bacteria. Antibiotic treatment should not be delayed
in a critically ill child until bacterial illness is confirmed, since the child may die during this period.
Empirical antibiotic treatment should be given to critically ill children, at the earliest opportunity once
SBI is suspected.
Recommendations
Number Recommendation
63 Give immediate parenteral antibiotics to children with fever presenting to specialist
paediatric care or an emergency department if they are:
184
shocked
unrousable
showing signs of meningococcal disease. [2007]
64 Immediate parenteral antibiotics should be considered for children with fever and
reduced levels of consciousness. In these cases symptoms and signs of meningitis
and herpes simplex encephalitis should be sought (see table 5.66 and Bacterial
meningitis and meningococcal septicaemia [NICE clinical guideline 102]). [2007]
65 When parenteral antibiotics are indicated, a third-generation cephalosporin (for
example, cefotaxime or ceftriaxone) should be given, until culture results are
available. For children younger than 3 months, an antibiotic active against listeria
(for example, ampicillin or amoxicillin) should also be given. [2007]
Aciclovir
Narrative evidence
Three EL 1- RCTs 197–199 looking at the treatment of serious illness with aciclovir were identified. Two
of the RCTs 197,198 compared vidarabine and aciclovir as treatment in adults and children with herpes
simplex encephalitis. The study which examined 208 adults reported more deaths (54% versus 28%,
P = 0.008) and increased mortality (38% versus 14%, P = 0.021) in the vidarabine recipients than in
the aciclovir recipients. 197 The study which looked at 210 infants less than 1 month old found no
difference between vidarabine and aciclovir in either morbidity (P = 0.83) or mortality (P = 0.27). 198
The third open-label RCT 199 estimated the treatment efficiency of high-dose aciclovir (HD, 60 mg/kg
per day), intermediate dose (ID, 45 mg/kg per day) and standard dose (SD, 30 mg/kg per day) with
regard to mortality and morbidity in 88 infants less than 28 days old. The survival rate for neonatal
herpex simplex virus infection was found to be 3.3 times higher in those children treated with HD
(OR 3.3, 95% CI 1.5 to 7.3). In addition, the children treated with HD aciclovir were 6.6 times more