Unfortunately, new and more resistant bacteria, such as methicillin-resistant Staphylococcus aureus (with skin and soft tissue infections) and Escherichia coli (with UTI) are now the most common causes of bacteremia and are equally capable of being invasive or leading to fulminant infection and sepsis. In the well-appearing febrile child who has no source but laboratory evidence of infection, such as an abnormal leukocyte count, elevated immature neutrophil percentage, or elevated inflammatory markers, such as C-reactive protein (CRP), some have suggested expectant therapy with a single parenteral dose of ceftriaxone pending culture results.4,6 However, presumptive antibiotic therapy has not been shown to prevent bacteremia.21 In addition, antibiotic therapy may have significant side effects, including promotion of bacterial resistance, gastrointestinal symptoms, and allergies. Reports of interaction between ceftriaxone and calcium-containing intravenous fluids, leading to lethal precipitation of crystalline material in the lungs and kidneys of neonates, have led to warnings against concomitant use of these two agents for all age groups. Antibiotics may also cloud further evaluation for serious illnesses such as meningitis. Given the extremely low risk of bacteremia and its sequelae, the best expectant therapy in the well-appearing child is close observation and follow-up pending culture results.