Febrile episodes in children with sickle cell disease treated on an ambulatory basis.

Children with sickle cell disease have a greatly increased potential for developing rapid and at times fatal sepsis from Streptococcus pneumoniae. Hospitalization and parenteral antibiotic treatment in all febrile children with sickle cell disease have thus become the standard of care at most sickle cell centers. As an alternative approach, we managed selected febrile children with sickle cell disease on an ambulatory basis with parenteral ceftriaxone to determine its safety and effectiveness in preventing sepsis and reducing the number of days of hospitalization. Twenty of 40 children who presented with significant fever met the study criteria and received ceftriaxone on an ambulatory basis. Three were subsequently hospitalized. Compared with a previous year, when all febrile children were admitted, ceftriaxone use reduced the days of hospitalization from 214 (6.3 +/- 1.6 days/patient) to 111 days (2.8 +/- 0.7 days/patient). The empiric use of ceftriaxone appears safe and effective, but it requires an expanded study over an extended period.