It is interesting to know whether or not early antibiotic treatment, started on an outpatient basis, affects the final outcome of bacteremia in children in a satisfactory condition. Despite the presence of a number of works that allow to compare the outcome of initially treated and untreated children with fever with asymptomatic bacteremia, none of them selected patients for treatment based on the random selection method.
The decision was made on the basis of clinical data, taking into account the results of such routine laboratory tests as the number of leukocytes and ESR. There is no doubt that this was the purposeful selection of patients for treatment. Thus, patients with a clear focus of infection, for example, with sepsis or pneumonia, were more widely prescribed antibiotics than patients with a suspected viral infection or fever with no local symptoms. Apparently, antibacterial treatment of younger patients and children with a painful appearance was also performed more often. Nevertheless, the consideration of these materials is of interest.
McCarthy presented data on 109 children with bacteremia who were observed in outpatient conditions. If at the first visit positive results of blood culture were obtained, then repeated seeding was carried out, as a rule, in 2-3 days. At the time of the first sowing of blood, antibiotic treatment was carried out in 84 children, and in 10% of them bacteremia was observed during repeated sowing.
Twenty-five children did not receive antibiotics during the first survey, and 44% of them still had bacteremia when they were retested. Analysis of this information using the h2 method showed that the difference was statistically significant (P <0.001). In addition, 3 out of 25 “inclined children developed meningitis, while none of the 84 children who received treatment had meningitis. This difference also proved to be significant (P <0.001).
In a retrospective study of asymptomatic pneumococcal bacteremia conducted by Bratton, 44 children received treatment, and 53 children did not receive therapy before receiving the results of blood culture. On examination after 2–3 days, “clinical improvement was noted in 84% of the children who received treatment, and only in 30% of untreated patients. When re-seeding blood, bacteremia was determined in 6% of those treated and in 29% of children who did not initially receive therapy.
In both groups, one child developed meningitis. The authors note that prescription of antibacterial drugs at the first visit to the doctor leads to a statistically significant increase in the frequency of sterile blood cultures when re-examined (P <0.01), Marshall also showed in a study of asymptomatic bacteremia caused by H. influenzae in initially not hospitalized children that early treatment with antibiotics leads to a significant improvement in the condition of patients (P <0.005).
In addition, none of the children who received antibiotic treatment at the first visit showed no bacteremia with repeated blood culture, while 10 of the 17 untreated children had a long bacteremia. Bacterial meningitis during repeated examinations was diagnosed in 1 of 22 treated patients and in 2 of 20 untreated children.
Thus, early treatment with antibiotics, even in ambulatory patients, can significantly ease (but not eliminate) prolonged bacteremia, meningitis, and other serious diseases.