New Febrile Infant Guidelines

From Ross Kuhner:

There were some recent guidelines published in Pediatrics by the AAP for febrile neonates. The ConeHealth pediatric team has put together these guidelines and joined with a multicenter trial to implement them (REVISE).

There is no flow sheet for newborns from 0-7 days. Should these infants who are younger than 7 days have a fever, hypothermia or other concerns for infection, we should obtain all cultures and give antibiotics and be admitted, (cbc, blood culture, ua, urine cx, and LP, and CSF culture). According to the new guidelines, now some patients will not need an LP in well appearing children greater than 21 days old. There are various smart phrases listed should you decide not to do an LP and why.

Also listed on these PDF files are the antibiotics guidelines for the various groups.

To access the guidelines, hover over Clinical Pathways on the above header and click on Febrile Infant.

Dragon and IVC Forms

Changing dragon settings will allow you to directly dictate into the PDF IVC forms. Follow these instructions.

1. Click on DragonBar Menu

2. Select Text Input

3. Select Use Basic Text Control, then click Apply All

This will allow you to dictate directly into the IVC petition form and first examination without using the dragon dictation box.

Treatment of Gonorrhea

The CDC has updated its recommendation for the treatment of uncomplicated gonorrhea in adults. Gonorrhea should now be treated with just one higher dose (500 mg) injection of ceftriaxone, and dual therapy is no longer the recommended approach.

CDC - Gonorrhea Treatment

1. Treat gonorrhea infections with a single 500 mg injection of ceftriaxone.

2. A test-of-cure is not needed for people who receive a diagnosis of uncomplicated urogenital or rectal gonorrhea unless symptoms persist.

3. A test-of-cure is recommended in people with pharyngeal gonorrhea 7-14 days after the initial treatment, regardless of the regimen.

4. Patients who have been treated for gonorrhea should be retested three months after treatment to ensure there is no reinfection.

5. As always, facilitate partner testing and treatment.

This essentially eliminates the option for Zithromax 1000mg single dose for coverage of Gonorrhea and Chlamydia. We need to administer the higher dose of Rocephin (was previously 250mg) to cover for Gonorrhea.

Rocephin alone does not cover Chlamydia. Additional coverage is necessary if chlamydia is suspected. Current CDC recommendations for treatment of Chlamydia are:

Recommended Regimens

• Azithromycin 1 g orally in a single dose OR

• Doxycycline 100 mg orally twice a day for 7 days

Alternative Regimens

• Erythromycin base 500 mg orally four times a day for 7 days OR

• Erythromycin ethylsuccinate 800 mg orally four times a day for 7 days OR

• Levofloxacin 500 mg orally once daily for 7 days OR

• Ofloxacin 300 mg orally twice a day for 7 days

TL;DR - Treat STD with Rocephin 500mg IM x1 and either Zithromax 1000mg x1 or Doxy 100mg PO BID x 7 days