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Abstract

Objective: Empirical antibiotic therapy in children with acute fever remains a controversial clinical issue. Fever is one of the most common presenting symptoms in pediatric care, yet most febrile episodes are self-limiting and attributable to viral infections. To evaluate the clinical evidence on empirical antibiotic therapy in febrile children, assess clinical outcomes, synthesize international guideline recommendations, and analyze the impact of sociocultural factors on prescribing practices. Methods: A narrative literature review was conducted using PubMed/MEDLINE, Embase, and Google Scholar (January 2014 – March 2025), supplemented by guideline databases from the World Health Organization (WHO), the European Society for Paediatric Infectious Diseases (ESPID), the National Institute for Health and Care Excellence (NICE), and the American Academy of Pediatrics (AAP). Studies addressing empirical antibiotic therapy decisions in pediatric populations were included. Results: Of 412 records identified, 28 studies met the inclusion criteria. Empirical antibiotic therapy was associated with improved survival in critically ill children but offered little clinical benefit in mild or self-limiting infections, while contributing to antimicrobial resistance (AMR). Parental expectations and clinician communication challenges were identified as major drivers of inappropriate prescribing. Conclusion: Current evidence supports a targeted rather than routine approach to empirical antibiotic therapy in pediatric fever. Evidence-based antimicrobial stewardship, effective clinician–parent communication, and adherence to international guidelines are essential to optimize clinical outcomes and reduce inappropriate antimicrobial use.

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