Fever is a presenting manifestation of several infectious and inflammatory diseases. In this article, Dr Anuj Rastogi shares his experience and views about managing one such emergency case.

Medication for fever

There are limited drugs which can help to pass your time to comfort children, especially after the complete ban of Nimesulide syrup which was an effective medicine for children above 1 year of age.

We are now left with 3 drugs- Brufen, Paracetamol and Mefenamic acid. Paracetamol is effective but not every time, hence doctors and parents are left with the option of adding Mefenamic acid and Brufen along with Paracetamol. Mefenamic acid and Brufen are double-edged swords that sometimes help and at times predispose children to fixed drug eruptions and toxic epidermal necrolysis.

The case

Recently, I treated an 8-year-old child who was running a high fever and was treated with paracetamol and mefenamic acid. He was presented with a maculopapular rash with targetoid lesions around the eyes and lips that had scattered asymmetrically all over the body. Few of them blistered and it was quite frightening to watch the child’s condition.

On the basis of his medical history, it was clear that he developed these lesions after Mefenamic acid. Immediately, the 2nd condition that busted into my mind was the chances of Fixed Drug Eruption (FDE) and Toxic Epidermal Necrolysis (TEN). TEN is a nightmare for any clinician but fortunately, the nikolsky sign of the patient was negative.

Treatment

I sought the advice of a senior dermatologist, who recommended three doses of Methylpred over three days, but the parents refused to give the child steroids. So now I was left with the option of IVIG and Cyclosporine. As IVIG is slightly expensive, we decided to opt for Cyclosporine 5 mg divided into 2 doses and within 24 hours.

The child started showing improvement 24 hours post-Cyclosporine administration.  Also, there were no new blister formations. It was relieving, as the fear of TEN was striked out. After 5 days the dosage of cyclosporine was reduced.

       Image 1: 2 days into the illness

       Image 2: At discharge

       Image 3: 9 days after discharge

Conclusion

The take-home message for all my colleagues is to counsel parents that fever itself usually causes no harm and that, at times, it can be a good thing.  It’s often a sign that the body is fighting an infection, and they should keep patience.  I prefer to prescribe paracetamol like any of my colleagues and ask kids to have an energy drink or ORS if signs of fever, vomiting and loose motions are seen.

The idea is to give these liquids by a spoon (1-2 spoons) every minute. It’s very important to understand how to give liquid by a spoon, as it becomes easier to give a 10 kg child 200 ml or 40 spoons in 20 minutes.

Early childhood illnesses are recurrent, self-limiting, and generally viral in nature. Energy drinks and/or ORS create a better difference than pumping lots of unnecessary medicine.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising paediatrician from Meerut.