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Baby has cough. Reduced after giving piritexyl. Developed fever. Suggest any effective medicine

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Dear Doctor,
My Son is 1.7 Yrs old and weighs 13.5 Kg. He has developed cough for the past 8 weeks. The first two weeks he was administered piritexyl cough syrup which reduced the cough. 3rd week we had been out for vacation and after returning, the 4th day he had a sudden rise in temperature upto 104 and he underwent febrile convulsion. He was admitted for 2 days while his ESR count was 26. He was administered monocef and cefodem. the cough and fever reduced to substantial level. The doctor advised to discontinue the medicines. He later after 3 days developed cough. He was advised Bricanyl for 1week. The next week he is now administered with Advante Forte 457 Mg and bricanyl. His latest reports says CRP - 7.7 and ESR 12. For the past 4 days after having advante forte he has fever around 100 every night. Kindly suggest and advise.
Posted Fri, 5 Apr 2013 in Child Health
 
 
Answered by Dr. Y V Siva Sankara Murty 3 hours later
Hi,

Thanks for writing to health care magic.

I request you to answer few questions so that I can answer your query better.

Is there any history of allergies in your kid? (like skin allergy or eye allergy)

Does you kid have any abnormal sound while breathing?

Is there any history of contact with a case of tuberculosis? Does any body around or a care taker etc. have chronic cough?

Did your kid aspirate or choke while consuming some thing recently? This history can be had from the care taker or mother. Was he given some thing like a ground nut to eat?

How is your kid breathing now? Is he breathing fast? (You can count the rate when he is sleeping quietly)

Are there any chest retractions? (Indrawing of chest during respiration)

Do you think your kid's cough increased or worsened over these days?

Is there any family history of bronchial asthma/ any other allergies?

Does anybody in the family have cough?

Is your kid breast fed or not?

How is his activity now? Is he playful or not?

Does his temperature go above 100 F or is it always below that?

Is there any weight loss recently?

Does your kid cough more at a particular time of the day?

What about the other investigations? Complete blood counts, Differential counts, leucocytes etc. Please mention any other report you could get your hands on.

What about the X XXXXXXX chest. Try to get a photograph of that. If that is not possible (do not worry) please mention the radiologists opinion.

Can you give the normal value of CRP in the lab in which it is done? (These values vary from lab to lab)

Was a montoux test done? If so what is the report?

Was a nebulisation given at any time? Is there any improvement with that?

I am sorry that I asked you so many questions. But a detailed answer will help me to answer your question better.

Waiting for your reply.

Dr Y V Siva Sankara Murty,

Associate professor,
Pediatrics.






Above answer was peer-reviewed by
 
Follow-up: Baby has cough. Reduced after giving piritexyl. Developed fever. Suggest any effective medicine 18 hours later
Dear Sir,

Please find the replies embedded.

Is there any history of allergies in your kid? (like skin allergy or eye allergy) - NO

Does you kid have any abnormal sound while breathing? - NO

Is there any history of contact with a case of tuberculosis? Does any body around or a care taker etc. have chronic cough? His Mother had tuberculosis a year before. Parallely the baby also underwent montaux test and turned negative. He was advised INH

Did your kid aspirate or choke while consuming some thing recently? This history can be had from the care taker or mother. Was he given some thing like a ground nut to eat? NO

How is your kid breathing now? Is he breathing fast? (You can count the rate when he is sleeping quietly) - NORMAL

Are there any chest retractions? (Indrawing of chest during respiration) - NO

Do you think your kid's cough increased or worsened over these days? - CONSISTENT FOR PAST 3 WEEKS

Is there any family history of bronchial asthma/ any other allergies? - NO

Does anybody in the family have cough? - NO

Is your kid breast fed or not? NOT BREASTFEEDED

How is his activity now? Is he playful or not?- PLAYFUL

Does his temperature go above 100 F or is it always below that? His temperature was around 100 for past 4 Days. Yesterday there was sudden rise in temperature upto 103. Today morning it was 104.2 Both the occasion he was given meftal and it has come down.

Is there any weight loss recently? - NO

Does your kid cough more at a particular time of the day? During Night after asleep and early morning while at the time of waking up.

What about the other investigations? Complete blood counts, Differential counts, leucocytes etc. Please mention any other report you could get your hands on. - Mature Polymorphs - 76; Bandforms 4

What about the X XXXXXXX chest. Try to get a photograph of that. If that is not possible (do not worry) please mention the radiologists opinion. - NORMAL

Can you give the normal value of CRP in the lab in which it is done? (These values vary from lab to lab) - 7.72

Was a montoux test done? If so what is the report? Last year when his mother had tuberculosis. It turned out to be negative.

Was a nebulisation given at any time? Is there any improvement with that?- Nebulisation was given 3 weeks before. Did not see any significant change.

Addl info: He is currently advised to continue with Advante Forte 457 mg; Azithral(new medicine frm today); Nutrolin B; Ventorlin & Coriminic.

Please let know for clarification required if any.
 
 
Answered by Dr. Y V Siva Sankara Murty 18 hours later
Hi,

Thanks for your reply.

The symptoms are suggestive of respiratory infection. Some of the investigations are also suggestive of infection. So your doctor started on antibiotics. Since there was no improvement with those antibiotics your doctor might have thought that the organism might be resistant to that particular antibiotic and changed it.

If there is no improvement with that Azithral your child may need further investigations (including a repeat X XXXXXXX chest, total blood counts, DLC, CRP etc) and treatment with higher antibiotics or Intravenous antibiotics.

I request you to monitor the following in your kid.

Monitor the respiratory rate. Count this when your kid is sleeping. If it is consistently rapid (even though there is no fever) then you will have to consult your doctor.
Look for any chest retractions.
Monitor the temperature.

If your kid remains febrile or develops retractions or rapid breathing then consult your doctor.

Please continue to write for any doubts to be clarified.
I will be more than happy to answer them.

Hope this helps.
Take care.

Dr Y V Siva Sankara Murty
Associate Professor
Pediatrics
Above answer was peer-reviewed by
 
Follow-up: Baby has cough. Reduced after giving piritexyl. Developed fever. Suggest any effective medicine 1 hour later
Dear Sir,

Thank You very much for reply. We are noting down the temperature. It is hovering around 100-102.5 three to four times a day. I have an small information required. Can we give him fruits? If so any particular fruit? Any particular type of food we have to give him? We are currently put him on idly and home made ragi malt. We are also giving him milk added with turmeric powder in the morning and amla juice once a day in the evening. Is their any other thing, we have to take care, as he has been on consistent medication/antibiotic for past 8 weeks.

Thank You,
XXXXXXX
 
 
Answered by Dr. Y V Siva Sankara Murty 1 hour later
Hi XXXXXXX

As far as his diet is concerned you can give him any fruit that he likes.
Only thing do not try new fruits that were not given before to your child. This is because some kids have food allergy to a particular item. This makes things confusing at this particular time.

Do not give oily foods during such episodes.

Whenever a child has cough its important to feed recurrently with small quantity feed. This is because they are more likely to vomit if they have a bout of cough if they are with a full stomach. So divide the same meal into small quantities and give it frequently.

Give food items prepared at home. (Not prepared out side)
Never give colored substances. (even when he does not have fever)
Never give him food when he is running fever. First get the temperature down with paracetamol and then give him the meal.
Calories are more important during such episode. The fever that he is having and infection that he has to fight require lot of protein and calories. Avoid fruits XXXXXXX in fiber during such episodes.

Please feel free to write further. I will be very happy to answer your questions.

Hope this helps.
Take care


Above answer was peer-reviewed by
 
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