APPROACH TO CHILDREN WITH

FEVER AND INDICATION OF

ANTIBIOTICS
By Nur Nabilah Mohd Nor
 Fever: elevation of body temperature >37.5’c. It is a normal body
reaction towards infection or other illness. It is not a disease but a
symptom
 Majority of children with fever have a self limiting viral infection
that resolves without any problem
 But in very young patient important to consider possibility serious
infections
HISTORY

 The following questions might be helpful:

• When did the fever start?
• How long has the fever been present?
• Has the child's activity significantly changed during the illness?
• Is the child tolerating fluids at home? Has the child been less interested in
eating?
• Has there been exposure to illness through babysitters, day care contacts, or
other caregivers? Are others at home sick
• Has there been any recent travel that might have exposed the child to illnesses?
• Associated with other symptoms, including diarrhea, vomiting, rhinorrhea,
cough, rash, and changes in weight or feeding habits.
• Check for immunization history
 Assess children with feverish illness, for the presence or absence of symptoms
and signs that can be used to predict the risk of serious illness using the
traffic light system (green, amber and red)
GREEN: LOW RISK

 Colour: normal colour of skin, lips and tongue

 Activity:
1. Respond normally
2. Smiles
3. Stays awake or awakens quickly if roused
4. Strong normal cry
 Breathing: normal
 Hydration: normal
 Other: generally normal, no fever at time of examination
AMBER: IMMEDIATE RISK
 Colour: pallor reported by parent
 Activity:
1. Not responding normally and decreased activity
2. Prolonged stimulation required to awaken child
 Breathing:
1. Nasal flaring
2. Tachypnea
3. Desaturation in air
4. Chest crackles
 Hydration:
1. Dry mucous membrane
2. Poor feeding
3. Reduced urine output
4. Crt >2sec
 Other: fever >5 days, swelling of limb or joint, a new lump >2 cm
RED: HIGH RISK
 Colour: pallor, mottled or blue
 Activity:
1. Unresponsive, appears ill
2. Weak high pitched cry or continuous cry
 Breathing: grunting, severe distress
 Hydration: reduced skin turgor
 Other:
1. Non blanching rash
2. Fever at time of examination
3. Bulging fontanelle
4. Neck stiffness
5. Seizures
MANAGEMENT: GREEN FEATURES

 No need for hospitalization

 Criteria for admission:
• Social and family circumstances
• Parents anxiety or concerns
• Child’s contact with serious illness
 If child discharged home, parents should be given clear instructions
about what to look for and when to call for medical help
1. Offer your child regular drinks
2. Looks for dehydration
3. Look for non blanching rash
4. If your child has convulsion/ abnormal movement
5. Keep your child off school or nursery
MANAGEMENT: RED OR AMBER FEATURES

 Need for admission

 Must watch out for sign of life threatening event such as respiratory distress or
shock  need urgent treatment (resuscitation)
 If no apparent source of infection despite fever, investigation should include
o FBC, CRP, electrolytes, Blood C&S
o UFEME
o CXR if respiratory sign present
o Lumbar puncture if meningitis is suspected
 Antipyretic: paracetamol or ibuprofen
 Empirical antibiotics should be administered: must be covered all likely pathogen
for patient age’s range until the result culture available, then to adjust
accordingly
ANTIBIOTICS
 Immediate treatment: 3rd generation of cephalosporin should be given to children
with fever and:
1. Sign of shock or coma
2. Sign of meningococcal disease
Empirical antibiotics
 Meningitis: IV Cefotaxime or IV Ceftriaxone
 Dysentry: IV Ampicillin
 Acute pharyngitis (outpatient): PO PenV or PO Amoxicillin
 Lower respiratory infection (pneumonia): PO Amoxicillin (outpatient), IV Augmentin
(inpatient)
 UTI:
1. 0-2 months: IV Ampicillin & IV Gentamicin
2. >2 months: IV Cefuroxime
REFRENCES

 Feverish Illness in Children NICE Guidline 2012

 OXFORD Handbooks of Paediatrics
 National Antimicrobial Gudline 2019
 Myhealth.gov.my