Children who present with FN and classified as low risk for complication have been increasingly managed with early discharge, or entirely as outpatients with daily re-evaluation.
This treatment philosophy has several potential advantages:
- Convenience for children and their families
- Improved quality of life
- Reduction of the incidence of nosocomial infections
- Reduction in the prolonged use of potent wide spectrum antibiotics
- Reduction in antibiotic related toxicity
- Reduction of the economic impact of admission to the hospital
Acceptance of outpatient therapy by doctors and families is however not universal. Studies have found multiple barriers to the implementation of such protocols 27.
Medical exclusion criteria usually adopted for outpatient treatment are stringent and only between a quarter to a third of patients are usually eligible.
Social barriers such as communication issues (language), distance from the hospital or reluctance from parents or physicians to pursue the strategy, can also prevent outpatient management. Nevertheless, this practice has been increasingly popular in the last decade and is the subject of several publications.
The usual process for those low risk patients consists of:
- A short course of observation (1-24 hours)
- Or hospitalisation followed by outpatient management with either an IV agent such as ceftriaxone or oral ciprofloxacin, along with daily re-evaluations.
Although a multi-centre trial on risk stratification is necessary to further assess the safety and efficacy of outpatient management in children, it seems to be a reasonable approach at this time in a defined subset of patients at low risk for bacterial sepsis.