Cautionary Note on the Use of Empiric Ceftriaxone for Suspected Bacteremia

Empiric use of parenteral ceftriaxone sodium is becoming increasingly prevalent in the treatment of suspected occult bacteremia in young, highly febrile children who lack an apparent focal infection other than presumed viral upper respiratory tract infection. This strategy has begun to pervade clinical practice in the absence of any published data to prove its efficacy. The authors of two recent exercises in decision analysis conclude that empiric antimicrobial therapy is the most cost-effective and clinically beneficial treatment startegy and recommend its use. 1,2 We write to express concern and urge caution in adopting this approach lest it further complicate the difficult task of treating occult bacteremia by requiring a more extensive evaluation and generating a potentially ambiguous database. Occult bacteremia is a relatively common problem in pediatric patients, occurring most often in children between ages 3 and 36 months with temperatures of at least 38.9°C. Numerous reports have identified an