March 2025
There has been an increase in serious bacterial infections due to severe Group A streptococcal, streptococcus pneumoniae and staphylococcal infections presenting as pneumonia, empyema, septicaemia, meningitis, and bone and soft tissue infections. These bacterial infections are often associated with, or subsequent to a viral infection.
Children can deteriorate rapidly and antibiotic treatment is time-critical and improves outcomes. Whenever serious bacterial infection is suspected in primary care, the first dose of effective antibiotics should be given as soon as possible* and the child referred urgently to hospital via ambulance or by Paediatric Infant Perinatal Emergency Retrieval (PIPER).
Think of serious bacterial infection in a child with fever (temperature >38° C) plus other symptoms and signs of a sick child, such as:
- erythematous, sunburn-like or purpuric skin rash
- lethargy, persistent drowsiness or high-pitched cry
- grunting, apnoea, hypoxaemia, or other signs of severe respiratory distress,
- pneumonia or pleural effusion
- cold or mottled limbs, >3 seconds capillary refill time, tachycardia
- severe limb pain or refusal to walk
- inability to feed or persistent vomiting
- decreased urine output.
No one sign is specific, but the more signs that are present, or the more severe, the more likely it is there is a serious bacterial infection. Prolonged fever (>5 days) or very high fever (temperature >40° C) are also more likely to indicate a serious bacterial infection. Parents of children with serious bacterial infections often correctly express concern about their failure to improve or their significant difference from normal.
*Take a blood culture if you can, but if not possible just give the antibiotics as diagnostic tests can be done at hospital.
Antimicrobial choice may include Ceftriaxone or Benzylpenicillin.
Paediatric Infant Perinatal Emergency Retrieval (PIPER) can be contacted from a primary care clinic or urgent care centre on 1300 137 650 for management and transfer advice and support.
Refer to the Royal Children’s Hospital Clinical Practice Guidelines: