ED Pathway for Evaluation/Treatment of Children with Sickle Cell Disease with Fever

Antibiotics, Treatment and Disposition

2 months - < 12 months months
≥ 12 months + NO Ceftriaxone within past 8 weeks
≥ 12 months + Ceftriaxone within past 8 weeks
Additional Considerations:
Acute Chest Syndrome (ACS) Ampicillin + Azithromycin
Ill appearing
Concern for meningitis/sepsis
Cefotaxime + Vancomycin
Observe 30 minutes following Ceftriaxone administration, monitor for signs of hemolysis.
If history of anaphylaxis to penicillin or any Cephalosporin reaction, give Clindamycin.

Antimicrobial Therapy

Determining Date of Last Ceftriaxone

Severe hemolytic reactions to ceftriaxone have been reported in patients with SCD. It is postulated that this may be an immune-mediated reaction related to recent ceftriaxone exposure.

Patients that Meet Low Risk Criteria

  1. Send CBC, Blood Culture
  2. Treat with ceftriaxone
  3. Review labs, H&P, VS with the Heme Fellow
  4. Assure that the Heme Fellow has contacted their Attending and Attending agrees with discharge
  5. Observe patient 2 hrs after ceftriaxone is given
  6. Assure good VS and stable PE just prior to discharge
  7. At discharge, assure that follow-up message to Heme is clicked in the SCD Discharge Smart Set