13 year old boy weighing 70 Kgs with fever for 4 days.
Advised for fever charting and paracetamol on 18 february 2013.
March 25 2013 update by father currently in PCMS Bhopal (Father's health record here at this link:http://care.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=242)
The boy was given Azithromycin 500 mg once daily by his local physician and the fever subsided in a day. No fever chart was maintained (unlike what you will find in figure 4 of his father's health record linked above).
Our impression: viral fever. Antibiotics (like azithromycin) are often used in the community for treating febrile illnesses possibly as it is otherwise difficult to rule out typhoid from viral fevers.
A survey on the attitudes of physicians from India revealed
fever as one of the compelling reasons to prescribe an
antibiotic.1
Many practitioners in the community resort to using an
antibiotic for any kind of
fever without bothering to localize the reason behind the
fever, hoping to hit the salmonella in case it turns out to be typhoid or the pneumococci if it is perhaps lurking somewhere.2
It is the uncertainty in diagnosis of
fevers, particularly the inability to distinguish a harmless viral
fever from a debilitating salmonella, that compels many physicians in the developing world to blindly start
antibiotics.3
In our experience
fever charting can be an invaluable means to help differentiate viral and enteric
fevers and thus help reduce unnecessary
antibiotic prescriptions for viral
fevers.
http://www.ncbi.nlm.nih.gov/pubmed/17576636References:
1. Sivagnanam G, Thirumalaikolundusubramanian P, Mohanasundaram J, Raaj
AA, Namasivayam K, Rajaram S. A survey on current attitude of practicing
physicians upon usage of antimicrobial agents in southern part of
India. MedGenMed. May 11 2004;6(2):1.
2. Biswas R, Dhakal B, Das RN, Shetty KJ. Resolving diagnostic uncertainty in initially poorly-localizable-
fevers: A prospective study. Int J Clin Pract. January 2004;58(1):26-28.
3. Bor DH, Makadon HJ, Friedland G, et al.
Fever in hospitalized medical patients: Characteristics and significance. J Gen Intern Med. 1988;3:119
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