Sickle Cell Disease with Fever — Antibiotics, Treatment and Disposition — Clinical Pathway: Emergency and Outpatient Specialty Care

Sickle Cell Disease with Fever Clinical Pathway — Emergency Department

Antibiotics, IVF and Disposition

Antibiotics

Goal: Rapid empiric antibiotic therapy after blood culture obtained.
Monitor for signs of hemolysis for 2 hours following ceftriaxone administration.

Indication First-Line Therapy Allergy to
First-Line β-Lactam
Assess Need for Alternative
Acute Chest Syndrome (ACS) Ampicillin
+
Azithromycin		 Clindamycin
+
Azithromycin
2 mos to < 12 mos
Admission Required		 Ampicillin Clindamycin
≥ 12 mos - 16 yrs
Eligible for Discharge		 Ceftriaxone
≥ 17 yrs
Eligible for Discharge		 Levofloxacin
One dose given in the
ED prior to discharge		 —
Children with IgE-mediated penicillin allergies (including hives, anaphylaxis) can still receive ceftriaxone

Viral Treatment

IV Fluids

  • Treat clinical dehydration/intravascular volume depletion with NS as indicated
  • If ACS is suspected/confirmed limit PO + IV to 2/3 maintenance

Disposition

Infants < 12 mos, and Children > 1 yr Who do Not Meet Low Risk Criteria Require hospital admission to observe for progression of disease and to monitor response to therapy
Children Who Meet
All Low Risk Criteria
  • Review clinical history, PE, labs with Heme Consultant
  • Monitor for signs of hemolysis for 2 hours following ceftriaxone administration
  • Assess VS, PE at the time of discharge
  • Use SCD Discharge Smart Set, ensure follow-up message to Heme sent