Fever

R50.0-1/R50.8-9

DESCRIPTION

Fever, i.e. temperature ≥ 38°C, is a natural and sometimes useful response to infection, inflammation or infarction.
Fever alone is not a diagnosis.
Fever may be associated with convulsions in children < 6 years of age, but is not a cause of the convulsions.

Note:

  • Temperature > 40°C needs urgent lowering, in children.
  • Fluid losses are increased with fever.
  • Malaria must be considered in anyone with fever who lives in a malaria endemic area, or who has visited a malaria area in the past 12 weeks.

GENERAL MEASURES

Children

  • Caregivers should offer the child fluids regularly to keep them well hydrated (where a baby or child is breastfed the most appropriate fluid is breast milk).
  • Dress child appropriately for the weather.
  • Ensure the child is rested.
  • Following contact with a healthcare professional, parents and carers who are looking after their feverish child at home should seek further advice if:
    • the child has a convulsion
    • the child develops a non-blanching rash
    • the parent or carer feels that the child is less well than when they previously sought advice
    • the parent or carer is more concerned than when they previously sought advice
    • the fever lasts >2 days

Note: Tepid sponging and evaporative cooling are not recommended, as this causes the child to shiver which actually increases the core temperature.

Adults
Maintain hydration.

MEDICINE TREATMENT

Consider treatment with paracetamol in adults with associated tachycardia, possibility of worsening cardiac conditions, and adults and children who are in distress.

Antipyretic agents are not indicated with the sole aim of reducing body temperature in children and adults with fever.

Children

Adults

  • Paracetamol, oral, 1 g 4–6 hourly when required to a maximum of 4 doses per 24 hours.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.

CAUTION

Do not treat undiagnosed fever with antibiotics, except in children < 2 months of age who are classified as having POSSIBLE SERIOUS BACTERIAL INFECTION.

Do not give aspirin to children and adolescents with acute febrile illness.

Children < 2 months of age, fulfilling any criterion of possible serious bacterial infection (see referral criteria):

  • Ceftriaxone, IM, 80 mg/kg/dose immediately as a single dose . See paediatric dosing tool.
    • Do not inject more than 1 g at one injection site.

CAUTION: USE OF CEFTRIAXONE IN NEONATES AND CHILDREN

  • If SUSPECTING SERIOUS BACTERIAL INFECTION in neonate, give ceftriaxone, even if jaundiced.
  • Avoid giving calcium-containing IV fluids (e.g. Ringer Lactate) together with ceftriaxone:
    • If ≤ 28 days old, avoid calcium-containing IV fluids for 48 hours after ceftriaxone administered.
    • If >28 days old, ceftriaxone and calcium-containing IV fluids may be given sequentially provided the giving set is flushed thoroughly with sodium chloride 0.9% before and after.
    • Preferably administer IV fluids without calcium contents
  • Always include the dose and route of administration of ceftriaxone in the referral letter.

REFERRAL

  • All children <2 months of age with any one of the following criteria of possible serious bacterial infection:
    • axillary temperature > 37.5°C
    • bulging fontanelle
    • decreased movement/only moves when stimulated
    • convulsions with current illness
    • decreased level of consciousness
    • breathing difficulties, i.e. respiratory rate > 60, nasal flaring, chest in-drawing or apnoea
    • pus forming conditions, i.e. umbilical redness extending to the skin or draining pus, many or severe skin pustules, pus draining from eye
  • All children in whom a definite and easily managed cause is not found.
  • Fever that lasts > 2 days without finding a treatable cause.
  • Fever that recurs.
  • Fever combined with:
    • signs of meningitis
    • coma or confusion
    • toxic-looking patient
    • jaundice
    • convulsion
    • failure to feed