Infant aged ≤1 month Admit for evaluation (blood, urine, CSF, ± stool, ± CXR and treatment with empiric antibiotics (ampicillin and gentamicin, or ampicillin and cefotxime Infant aged 2–3 months Consider rapid influenza testing in flu season Toxic or non–low risk: admit and evaluate as above and treat with ceftriaxone Nontoxic, low risk: CBC and blood culture Urinalysis and urine culture Lumbar puncture if WBC >15,000 or <5000 Consider empiric antibiotics Return for reevaluation within 24 hours Low-risk criteria: Clinical Previously healthy, term infant with uncomplicated nursery stay Nontoxic appearance No focal bacterial infection on examination (except otitis media) Laboratory WBC count 5000–15,000/mm3, ≤1500 bands/mm3 Negative gram stain of unspun urine (preferred), or negative urine leukocyte esterase and nitrite, or ≤5 WBCs/HPF CSF ≤8 WBCs/mm3 and negative gram stain Child aged 3 months to 3 years Consider rapid influenza testing in flu season Toxic: admit and evaluate as above and treat with ceftriaxone Nontoxic: CBC and blood culture rarely recommended Urinalysis and urine culture obtain via cathetherization or clean catch Lumbar puncture rarely recommended CXR if T >39°C, respiratory distress, tachypnea, rales, WBC count >>20,000/mm3 Symptomatic treatment for fever Consider empiric antibiotics Return if fever persists ≥48 hours or if condition deteriorates Admit for inpatient monitoring if good outpatient follow-up not available |