BMC Public Health 2009, 9:300 http://www.biomedcentral.com/1471-2458/9/300 Initial approach to the well-appearing young child with fever without source, with relation to his/her PCV vaccination status The proportion of participants who report to "wait-and see" was 60.7% (419/690), if the child was not vaccinated with PCV and increased to 74.2% (n = 512/690) if the child had received PCV (P < 0.0001). Also, physicians would obtain blood tests less frequently in the vaccinated than in the not-vaccinated child (139/690 [20.1%] vs. 205/690 [29.7%]). Empiric antibiotic therapy would be started by 3.0% (21/690) of pediatricians/pediatric resi- dents if the child had received PCV vs. 7.5% of participants (52/690) if the child was unvaccinated (P < 0.0001) (Table 1). No significant difference was evidenced among physician categories (P = 0.105 considering not-vacci- nated child; P = 0.396 considering the vaccinated child, by Pearson χ2 test among categories). Approach to the well-appearing young child with fever without source and white blood cell count = 17,5000/μL, with relation to his/her PCV vaccination status Participants were asked how they would have managed the child if he/she had shown white blood cell count of 17,500/μL. The proportion of physicians who reported to send the child home with no antibiotic therapy raised from 33.2% (229/690) for the not-vaccinated to 46.5% (321/690) for the vaccinated child (P < 0.0001). A signif- icantly lower proportion of physicians reported to ask for erythrocyte sedimentation rate (P < 0.017), C reactive pro- tein (P < 0.0001), blood culture (P = 0.022), urine analy- sis/or dipstick (P = 0.028), in the child vaccinated with PCV (Table 2). Investigations would be obtained after 2.2 days of fever (median 2.2; IQR:2.0–3.5 days) with no sig- nificant difference regarding the PCV vaccination status. No significant difference was observed among physicians' categories. Preferred antibiotic treatment for empiric therapy Oral therapy with amoxicillin or amoxicillin/clavulanic acid was the preferred option by 609/690 (88.3%) partic- ipants. Ceftriaxone was chosen by 16/690 (2.3%) physi- cians (Table 3). No significant difference was observed among physicians' categories (P = 0.864). Use of quick tests by primary care pediatricians in the office setting In general, among the 300 primary care pediatricians who returned the questionnaire, quick test for C reactive pro- tein was reported to be routinely performed by 100/300 (33.33%), urine dipstick test by 293/300 (97.33%), and Group A β haemolitic streptococcus rapid test by 206/300 (68.67%). Attitude toward PCV recommendation Four-hundred-sixty-one (66.81%) participants reported that they to recommend PCV vaccination to all children, while 208 (30.14%) recommend it only in the presence of siblings or day care attendance. Seventeen (2.46%) physi- cians would never recommend PCV. Finally, 2 (0.29%) pediatricians recommend PCV only in children with a chronic disease, and 2 (0.29%) did not answer. No signif- Table 1: Change in physicians' self-reported, initial approach to the well-appearing young child, with relation to PCV vaccination status Blood examination n (%) Empiric antibiotic treatment n (%) Wait-and see n (%) Not answer n (%) P * Not vaccinated child Vaccinated child Primary care pediatricians Hospital Pediatric pediatricians residents Total Primary care pediatricians Hospital Pediatric pediatricians residents Total 76 (25.3) 82 (32.7) 47 (33.8) 205 (29.7) 55 (18.3) 52 (20.7) 32 (23.0) 139 (20.1) 19 (6.3) 19 (7.6) 14 (10.1) 52 (7.5) 7 (2.3) 7 (2.8) 7 (5.0) 21 (3.0) 197 (65.7) 147 (58.6) 75 (54.0) 419 (60.7) 228 (76.0) 188 (74.9) 96 (69.1) 512 (74.2) 8 (2.7) 3 (1.2) 3 (2.2) 14 (2.0) 10 (3.3) 0.013 4 (1.6) <0.0001 4 (2.9) 0.021 18 (2.6) <0.0001 Note. * vaccinated vs. non vaccinated child, by Pearson χ2 test Page 3 of 7 (page number not for citation purposes)