The records of 559 consecutive outpatient children with unsuspected
bacteremia (467 Streptococcus pneumoniae) were reviewed. When compared with patients receiving oral or parenteral
antibiotics, those patients who received no
antibiotics at the initial visit were in follow-up: (1) less likely to be improved (32% vs. 86%, P < 0.01); (2) more likely to be febrile (75% vs. 28%, P < 0.01); (3) more likely to be hospitalized (67% vs. 22%, P < 0.01); (4) more likely to have persistent
bacteremia (28% vs. 3%, P < 0.01); and (5) more likely to have new
focal infections (13% vs. 5%, P < 0.01). Compared with patients receiving parenteral
antibiotics at the initial visit, patients receiving oral
antibiotics were in follow-up: (1) less likely to be improved (81% vs. 89%, P < 0.05); and (2) more likely to have persistent
bacteremia (5% vs. 0%, P < 0.05). There was no statistical difference between patients receiving parenteral or oral
therapy in the development of
focal infections, although children with new
focal infections receiving oral
antibiotics more often had persistent or new positive cultures. No patients receiving parenteral
antibiotics at the initial visit had positive blood or spinal fluid cultures at the follow-up visit. Analyses of the subgroups with (1) occult
bacteremia with all organisms, (2) unsuspected
bacteremia S. pneumoniae and (3) occult
bacteremia with S. pneumoniae show results similar to those for the entire group.(ABSTRACT TRUNCATED AT 250 WORDS)