What are the discharge orders for an 8-month-old female patient with lower respiratory tract infection (LRTI) who was treated with ceftriaxone (Ceftriaxone) intravenous (IV) for 5 days, is afebrile (fever-free) for 24 hours, and has a mild cough with stable vital signs (VS)?

Discharge Orders for 8-Month-Old Female with LRTI

Antibiotic Therapy at Discharge

Transition to oral antibiotics for 1-4 weeks to complete a total treatment course of approximately 10 days from initial presentation. 1

• Recommended oral antibiotic: Amoxicillin 40-50 mg/kg/day divided twice daily for 3-5 additional days (total 10 days of therapy including IV ceftriaxone) 1
• Alternative options if amoxicillin is not suitable include cephalexin 20 mg/kg/dose twice daily or other appropriate oral agents based on local resistance patterns 2
• The transition from IV to oral therapy is appropriate after 5 days of IV ceftriaxone with 24 hours afebrile and clinical improvement 1
• Total treatment duration of 10 days has been best studied, though shorter courses may be equally effective for mild disease 1

Rationale for Oral Transition

• Clinical improvement demonstrated by: afebrile status for 24 hours, stable vital signs, and only mild residual cough 1
• Transition to oral therapy can occur as early as 2-3 days after starting parenteral therapy in the absence of bacteremia or secondary foci 1
• This patient has received 5 days of IV therapy, exceeding the minimum required for transition 1

Monitoring and Follow-Up

Schedule outpatient follow-up in 2-3 days to assess clinical response and ensure continued improvement. 1

• Parents should monitor for: worsening cough, recurrence of fever, increased work of breathing, decreased oral intake, or lethargy 1
• Clinical improvement is expected within 48-72 hours of adequate therapy; lack of improvement warrants re-evaluation for resistant organisms or alternative diagnoses 3

Return Precautions

Instruct caregivers to return immediately if:

• Fever recurs (temperature ≥38°C/100.4°F) 1
• Respiratory distress develops (increased breathing rate, retractions, grunting) 1
• Decreased activity, poor feeding, or inability to maintain hydration 1
• Worsening cough or new symptoms develop 1

Supportive Care Instructions

• Ensure adequate hydration with age-appropriate fluids 1
• Use saline nasal drops and bulb suction as needed for nasal congestion 1
• Avoid exposure to tobacco smoke and other respiratory irritants 1
• Acetaminophen or ibuprofen (if >6 months) for discomfort as needed 1

Activity and Diet

• Resume normal age-appropriate diet as tolerated 1
• Gradual return to normal activity level as symptoms improve 1
• No daycare restrictions once afebrile for 24 hours and clinically improved 1