1-3 Months with Fever Greater Than 38ºc (100.4ºf)

BOSTON PROTOCOL

1-3 months with fever greater than 38ºC (100.4ºF)

Low Risk

No immunizations or antimicrobials within the preceding 48 hours

No evidence of dehydration, ear, soft tissue, or bone infection

Overall well appearance

Caretaker available by telephone

Peripheral white blood cell (WBC) count less than 20,000/microL

CSF with WBC <10/microL

UA <10 WBC per high-powered field

No infiltrate on chest radiograph if one was obtained

Recommendation: 50 mg/kg ceftriaxone intramuscularly and send home with scheduled follow-up visit 24 hours later.

PHILADELPHIA PROTOCOL

1-2 months with fever ≥38.2ºC (100.8ºF)

Low Risk:

WBC <15,000/microL

Band-neutrophil ratio <0.2

UA <10 WBC/hpf and a negative urine Gram stain

CSF <8 WBC/microL and a negative CSF Gram stain

Chest radiograph lacking an infiltrate if one was obtained

Stool without blood and few or no WBCs on the smear

Recommendations: high-risk patients to be hospitalized and treated with empiric antibiotics. Low-risk patients discharged to follow-up within 24 hours.

ROCHESTER PROTOCOL

<2 months of age with fever ≥38.0ºC or 100.4ºF

Low risk:

≥37 weeks gestation, and hospitalized no longer than the mother

Infant was previously healthy

Infant was well-appearing, with no ear, soft tissue, or bone infections

Laboratory criteria were as follows:

WBC 5,000 to 15,000/microL with an absolute band count <1,500/microL

Urinalysis with <10 WBC/hpf and no bacteria seen

Stool with <5 WBC/hpf if obtained

Recommendations: High-risk infants were hospitalized with empiric antibiotics, and low-risk patients were sent home without antibiotics but with reliable follow-up.