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Fever - MSF Medical Guidelines
Fever - MSF Medical Guidelines
Fever - MSF Medical Guidelines
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Signs of severity
Aetiological treatment
Symptomatic treatment
Prevention of complications
Signs of severity
Severe tachycardia, tachypnoea, respiratory distress, SpO2 ≤ 90%.
Shock, altered mental status, petechial or purpuric rash, meningeal signs, seizures, heart murmur,
severe abdominal pain, dehydration, critically ill appearance a ; a bulging fontanel in young
children.
In endemic area, always consider malaria.
If the patient is ill appearing a and has a persistent fever, consider HIV infection and
tuberculosis, according to clinical presentation.
Aetiological treatment
Antibiotherapy according to the cause of fever.
For patients with sickle cell disease, see Sickle cell disease, Chapter 12.
If no source of infection is found, hospitalise and treat the following children with
empiric antibiotics:
Children less than 1 month;
Children 1 month to 3 years with WBC ≥ 15000 or ≤ 5000 cells/mm3;
All critically ill appearing a patients or those with signs of serious illness;
For antibiotic doses according to age, see Acute pneumonia, Chapter 2.
Symptomatic treatment
Undress the patient. Do not wrap children in wet towels or cloths (not effective,
increases discomfort, risk of hypothermia).
Antipyretics may increase the patient’s comfort but they do not prevent febrile convulsions. Do not
treat for more than 3 days with antipyretics.
paracetamol PO
Children less than 1 month: 10 mg/kg 3 to 4 times daily (max. 40 mg/kg daily)
Children 1 month and over: 15 mg/kg 3 to 4 times daily (max. 60 mg/kg daily)
Adults: 1 g 3 to 4 times daily (max. 4 g daily)
or
ibuprofen PO
Children over 3 months and < 12 years: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)
Children 12 years and over and adults: 200 to 400 mg 3 to 4 times daily (max. 1200 mg daily)
or
acetylsalicylic acid (ASA) PO
Children over 16 years and adults: 500 mg to 1 g 3 to 4 times daily (max. 4 g daily)
Prevention of complications
Encourage oral hydration. Continue frequent breastfeeding in infants.
Look for signs of dehydration.
Monitor urine output.
Notes:
In pregnant or breast-feeding women use paracetamol only.
In case of haemorrhagic fever and dengue: acetylsalicylic acid and ibuprofen are
contraindicated; use paracetamol with caution in the presence of hepatic dysfunction.
Footnotes
(a) Critically ill appearing child: weak grunting or crying, drowsiness, difficult to arrouse, does not smile,
unconjugate or anxious gaze, pallor or cyanosis, general hypotonia.