Sickle Cell Disease with Fever Clinical Pathway – Emergency Department – Antibiotic Therapy

Sickle Cell Disease with Fever Clinical Pathway – Emergency Department

Antibiotic Therapy for Sickle Cell Disease with Fever

General Principles

  • Administer empiric antibiotic therapy promptly after blood culture is obtained as able
    • Do not delay administration of antibiotics if concerned for sepsis
  • Monitor for signs of hemolysis for 2 hours following ceftriaxone administration

Common Pathogens

  • S. pneumoniae (pneumococcus)
  • Salmonella species
  • Nontypeable Haemophilus influenzae
  • Escherichia coli
  • Neisseria meningitidis
Indication First-Line Therapy Allergy to First-Line β-Lactam
Assess Need for Alternative
Acute Chest Syndrome (ACS) All Ages
  • Ampicillin, IV
    • 50 mg/kg/dose every 6 hours
      Max: 2,000 mg/dose
  • Clindamycin, IV
  • 14 mg/kg/dose every 8 hours
    Max: 900 mg/dose

Azithromycin, PO and IV

  • < 50 kg:
    • 10 mg/kg/dose on day 1
      Max: 500 mg/dose
    • then
    • 5 mg/kg/dose once daily, days 2–5
      Max: 250 mg/dose
  • ≥ 50 kg:
    • 500 mg on day 1
    • then
    • 250 mg once daily, days 2–5
  • 2 mos to < 12 mos
  • or
  • ≥ 12 mos and All Low-Risk Criteria Not Met
  • Admission Required
  • Ampicillin, IV
    • 50 mg/kg/dose every 6 hours
      Max: 2,000 mg/dose
  • Clindamycin, IV
    • 14 mg/kg/dose every 8 hours
      Max: 900 mg/dose
  • ≥ 12 mos
  • All Low-Risk Criteria Met
  • Eligible for Discharge
  • Ceftriaxone, IV
    • 100 mg/kg/dose once
      Max: 2,000 mg/dose
    • Monitor for 2 hours after administration

Review the CHOP Formulary for complete drug information.

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

  • 2 mos to < 12 mos
  • or
  • ≥ 12 mos and All Low-Risk Criteria Not Met
 Require hospital admission to observe for progression of disease and to monitor response to therapy
≥ 12 mos All Low-Risk Criteria Met
  • Review clinical history, PE, labs with Heme Consult to confirm all low-risk criteria for discharge are met
  • Monitor for signs of hemolysis for 2 hours following ceftriaxone administration
    • Pallor, change in mental status, headache
    • Tachycardia, hypotension
    • Tachypnea
    • Abdominal, back pain
  • Assess VS, PE at the time of discharge
  • Use SCD Discharge Smart Set, ensure follow-up message to Heme sent