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Q. What medicines can be given to a 4-year-old child to treat occult sepsis?

Answered by
Dr. Faisal Abdul Karim Malim
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 15, 2018

Hello doctor,

My 4-year-old daughter who weighs 13.5 kg is having fever ranging from 100 to 102 degrees Fahrenheit since three to four days. Syrup Calpol 250 works only for one to two hours max, after which fever spikes. We gave Meftal syrup too, which works maximum for three hrs. We did a CCB and urine test. WBC count is 22,000 and she has 80% neutrophils. Platelets are normal. Urine is clear. There are no other symptoms other than the fever. Now, she has developed severe nausea and intermittent vomiting. We started Cefixime 100 mg BD, but nothing changed after four doses. In fact, it got worse. So we admitted to a pediatric hospital. They started IV Ceftriaxone and Febrinil. After the first dose, the fever partially subsided but recurred in only one and a half hours. She also has a papular rash which is very indistinct and pale red (not erythematous) over the trunk. I am worried as the food intake is very low and she has begun to appear toxic. The pediatrician has said that she is having occult sepsis. I am worried about the prognosis and considering her to shift to the ICU. What should I expect from the current line of treatment?

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Hello,

Welcome to icliniq.com.

  • As per the report, the WBC (white blood cell) count is quite high. It is advisable to do a blood culture also to find out what organism has affected her.
  • Also, I would want to add one more antibiotic to Ceftriaxone as it does not seem to be responding well.
  • If the condition of the child is bad, she should be shifted to the ICU (intensive care unit).
  • Also if the fever does not subside in the next 48 hours, a detailed investigation including an X-ray of the chest and an ultrasound of the abdomen should be done to rule out the cause of the fever.

For more information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician

Thank you doctor,

The pediatrician said that this is only a single dose of Ceftriaxone until now. We have to wait for at least a second dose and then decide whether to change the antibiotic or not. My question is having such a high fever even after taking Ceftriaxone is considered a failure?

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Hello,

Welcome back to icliniq.com.

  • For any antibiotic to act, it should be given for a period of 72 hours.
  • If the child does not respond to that then that antibiotic is mostly not working and either a combination or another antibiotic may be required.
  • Hence I think as only 24 hours have passed since Ceftriaxone, we need to wait for 48 hours more.

For more information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician

Thank you doctor,

Actually, it has been eight hours since the first Ceftriaxone injection. I guess it is a waiting game. Thanks for your time.

#

Hello,

Welcome back to icliniq.com.

  • Fine. We will wait and see.

For more information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician

Thank you doctor,

Her blood tests were done today morning before starting the Ceftriaxone. It showed WBC count of 10,700. That is less than half of the earlier count done two days back. When we got the 22,000 WBC count report, we started Cefixime in response to that. Do these reports seem correct? Can the WBC count fall to less than half in two days?

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Hello,

Welcome back to icliniq.com.

  • Yes, it is possible.
  • If this has happened then fever should also subside soon.
  • It seems to be a good sign.

Regards.

For more information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician

Thank you doctor,

Ceftriaxone has been completed for four doses now. The fever showed a spike after the fourth dose to 102.4 F. The level of fever control was same as that was before we got her admitted. After an antipyretic, the response starts after one hour and again this spikes to at least 100.5 F. So, the doctor on our request sent her for blood culture, malaria rapid and dengue, IgM, and IgG. Also, again we suggested that if the Ceftriaxone is showing not much improvement in 36 hours then we can start higher antibiotics. One pediatrician also suggested that actually Amikacin also should be added. However, only Piperacillin and Tazobactum were started. Now it has been four to five hours after initiating the higher antibiotic. What else can be done to get her better?

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Hello,

Welcome back to icliniq.com.

  • Please refer to my previous message where I have mentioned 72 hours and not 36 hours.
  • In the meanwhile, if the reports are suggesting some particular organism then an appropriate antibiotic can be started accordingly.

For more information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician

Thank you doctor,

They are continuing with Piperacillin and Tazobactum. Also, a different pediatrician to whom we contacted earlier suggested that Amikacin should have been added along with earlier Ceftriaxone injections. Meanwhile malaria rapid is negative, dengue is negative, chest X-ray is clear and the ultrasound of the abdomen suggested mild hepatomegaly. No source of infection is identified yet. WBC done recently came as 6600. Even with low WBC counts, how come the fever is still there? Currently, my child is still getting spikes of fever up to 101 to 102 F. When we give Febrinil injection, the fever starts coming down only after one hour but once it is normal, it stays for one hour max and it shoots up to 101 again. Now we cannot just repeat Febrinil so frequently. I hope what we are doing is right. Also is it true that rapid malaria test can come falsely negative upon Paracetamol treatment?

#

Hello,

Welcome back to icliniq.com.

  • Has the blood culture been done?

For more information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician

Thank you doctor,

Actually, they sent the blood culture yesterday just before starting the Piperacillin and Tazobactum injection. They said it will take 48 hours to show something and five days to get a complete picture. I had actually requested right on admission that they should take the sample for blood culture. I am really worried.

#

Hello,

Welcome back to icliniq.com.

  • Fine. Piperacillin and Tazobactum is a good choice but we need to know the culture reports too.

For more information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician

Thank you doctor,

My daughter is having a controllable fever with Calpol for up to four to five hours and sometimes haphazardly to 10 hours. So, the pediatrician advised discharging with IV line patent so that remaining two days of Piperacillin and Tazobactum could be completed. In the meanwhile, we have come to know that 12 out of 30 children in her class are sick with similar symptoms (none are admitted yet) at the same time. My other daughter (her twin) also is developing fever in spike very similar to the other one. We started Calpol for her and the pediatrician suggested Linezolid TDS syrup for her. Is that the right choice of antibiotic? Considering her sister showed not much response to Ceftriaxone and Cefixime, can we add the same combination of antibiotics for her?

#

Hello,

Welcome back to icliniq.com.

  • I do not think this is required.
  • As per the specific history provided, this seems to be a viral infection.
  • There would be no use of adding another antibiotic.

For more information consult a paediatrician online --> https://www.icliniq.com/ask-a-doctor-online/paediatrician


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