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Chapter: Paediatrics: Infectious diseases

Paediatrics: Fever: management (red or amber features)

Children with red/amber features need admission. Those with red fea-tures have life-threatening illness and need urgent treatment.

Fever: management (red or amber features)

 

Children with red/amber features need admission. Those with red fea-tures have life-threatening illness and need urgent treatment.

In hypoxic children or those in shock.

If there is no apparent source of infection, despite fever, then the investigations should include the following:

   Blood—culture, FBC, CRP, electrolytes;

   Urine—test for UTI;

   lumbar puncture—consider if the clinical assessment dictates and there are no contraindications;

   CXR—consider if high white blood cell count.

 

 

Antibiotics

 

Immediate treatment

 

Maximum dose third-generation cephalosporins (cefotaxime or ceftriax-one) should be given to children with fever and:

   signs of shock or coma

 

   signs of meningococcal disease

 

Consider giving high dose IV aciclovir if suspect herpes simplex encepha-litis or disseminated neonatal disease.

Consider giving IV corticosteroid if confirmed bacterial meningitis (but not in infants younger than 3mths

 

Treatment for suspected bacterial infection

 

Give third-generation cephalosporin if any of the following are sus-pected

   Neisseria meningitidis

 

   Streptococcus pneumoniae

 

   Escherichia coli

 

   Staphylococcus aureus

 

   Haemophilus influenzae type b

 

Special cases

 

Consider choice of antibiotics or route of administration carefully in the following instances:

   Child <3mths: add antibiotic against listeria (e.g. ampicillin)

 

   Child with decreased level of consciousness: give parenteral antibiotics.

 

   Significant rates of antibiotic resistance: follow local guidelines

 

Antipyretics

 

Fever should be treated if the child is unwell with it:

Do not use tepid sponging.

 

Do not over- or underdress the child.

 

   Only use paracetamol or ibuprofen if the child is distressed with fever.

 

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