Study designs of evaluations included in the review
Reports were included if they contained the following: a series of children with streptococcus pneumonia bacteraemia treated as outpatients, patients were divided either retrospectively or prospectively into non-treatment and treatment groups and there were descriptions of all patients on follow-up to determine whether a serious infection was present. Excluded were reports in which either an oral antibiotic group or a non-treatment group was absent.
Specific interventions included in the review
Oral antibiotics including penicillin, amoxycillin, ampicillin, sulphamethoxazole, trimethoprim, erythromycin, sulfisoxazole, dicloxicillin and cephalosporins.
Participants included in the review
The participants were children designated as having streptococcus pneumonia occult bacteraemia if they were well-appearing, had no major focus of infection and streptococcus pneumonia was recovered from blood cultures on their initial physician visit. The children were treated in the following settings:private practice, emergency department, walk-in clinics and clinics. Cases were excluded from analysis for the following reasons: the patient was immunocompromised, at initial presentation serious bacterial infection was present, parenteral antibiotics were administered or the child was described as " ill appearing" or "toxic", the Yale observation scale was greater than 10 or the child underwent a lumbar puncture.
Outcomes assessed in the review
The main outcome assessed was serious bacterial infection defined as pneumonia, meningitis, soft-tissue infection and bone or joint infections. Not included as serious bacterial infection were persistent bacteraemia and persistent fever, unless a focus of infection developed, otitis media, bronchitis and sinusitis.
How were decisions on the relevance of primary studies made?
Each report was independently analysed to ascertain if the report conformed to the inclusion criteria. Disagreements were settled by consensus.