Fever Without a Focus Treatment & Management

Updated: Sep 01, 2021
  • Author: Saul R Hymes, MD, FAAP; Chief Editor: Russell W Steele, MD  more...
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Medical Care

For children with fever without a focus who appear ill, conduct a complete evaluation to identify occult sources of infection. Follow the evaluation with empiric antibiotic treatment and admit the patient to a hospital for further monitoring and treatment pending culture results. Because children presenting with fever and leukopenia are also a concern, consider leukocytosis and leukopenia in making decisions about empiric antibiotic therapy. According to a study by Gomez et al, isolated leukopenia, especially in children without leukocyturia suggestive of a UTI, may not be a significant risk factor for SBI and viral etiologies may be considered more strongly. [18]

Patients aged 2-36 months may not require admission if they meet the following criteria:

  • Patient was healthy prior to onset of fever.

  • Patient is fully immunized.

  • Patient has no significant risk factors.

  • Patient appears nontoxic and otherwise healthy.

  • Patient's parents (or caregivers) appear reliable and have access to transportation if the child's symptoms should worsen.

Treatment recommendations for children with fever without a focus are based on the child's appearance, age, and temperature.

For children who do not appear toxic, treatment recommendations are as follows:

  • Schedule a follow-up appointment within 24-48 hours and instruct parents to return with the child sooner if the condition worsens.

  • Hospital admission is indicated for children whose condition worsens or whose evaluation findings suggest a serious infection.

For children who appear toxic, treatment recommendations are as follows:

  • Admit child for further treatment; pending culture results, administer parenteral antibiotics.

  • Initially administer ceftriaxone, cefotaxime, or ampicillin/sulbactam (50 mg/kg/dose).


The need to consult with specialists depends on the specialty of the physician who initially evaluated the patient and the ultimate source of fever. Typically, general pediatricians easily manage febrile infants on both an inpatient and outpatient follow-up basis.


Diet and Activity


Patient tolerance is the only restriction on diet. Physicians should monitor intake and output as an indication of the patient's status because these measurements may provide the first evidence of a disturbance that indicates illness.


Patient tolerance also determines activity level, which should be monitored for changes (eg, lethargy, irritability).