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Are Cefpodoxime And Paracetamol The Right Medication For Fever In Children?

Posted on Thu, 16 Jun 2016

Question: Hi,

My daughter of 4.5 years old is having stomach pain and fever since 5 days. Her "Widal Slide Agglutination test" report says, O antigen is 1.80 and H antigen is 1.40. What does it means??

She has given with syp. Cefpodoxime 100 2times, Paracetamol 250mg SOS 5ml, syp. Levofloaxacin 5ml 2times, Dortin DS for abdominal pain and Serax forte tab.

Wanted to know are these correct medicines to treat her dease or she need any other test or medicines.adding to my previous post, she has high fever 104F to 105F most of the time. After a dose of Paracetamol, fever went down near to normal but not normal and it tends to increase afert 3-4 hrs again back to high 104F. I am kind of scared.
Don't know what to do??

please advise ..

Thanks,
XXXXX

Answered by Dr. Pradeep Kumar Jain (1 hour later)

Brief Answer:
Widal test is negative and dosage are appropriate for age

Detailed Answer:
Hello

Thanks for the query.
I have gone through the details and do understand your concern.
Enteric fever(Typhoid) is a common cause of pain abdomen and fever in this age.Apart from typhoid there are other common causes like viral gastritis and heat exaution(during summer).But as fever is there for 5 days bacterial infection must be ruled out.

Widal test of titre O antigen 1:80 and for H 1:40 is negative. Widal test is usually advised after 7 days of fever when typhoid is a strong suspicion(as before 7 days sensitivity is very low).Blood culture should be done instead of widal during initial 7 days.
For 4.5 years baby assuming weight of 16-20 kgs the dosage are appropriate.
The dose of paracetamol is 60 mg/kg/day and it can be given 4-6 times a day.
If fever is not responding to paracetamol(when given in appropriate dosage) you may give mefenemic acid after consulting your pediatrician.

Please let me know for how many days she is getting this treatment.If fever is there even after 72 hours of antibiotic dosage she may need further investigations like complete blood count,CRP(c reactive protein),blood culture and urinary test to find out the cause.

I hope this helps.
Please let me know if you have any more query.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (1 hour later)

Thank you Dr. for looking into it and providing detailed info.
My daughter initially having problem with loose motion, stomach pain and fever 10 days earlier from today.
She has initially given with Ofloxacin 100 and Flgyl and Ibugesic Plus for fever. She took it of 3 days and fever and loose motion stopped, but she has complaint for stomach pain.
The the same medicine continued for 3 more days, but stomach pain still persist and fever like 101-102F.

Answered by Dr. Pradeep Kumar Jain (1 hour later)

Brief Answer:
I would like to get her investigated for severity of infection

Detailed Answer:
Thanks for providing the details

The current illness is most likely related to the previous one.I would like to get a complete blood count,c reactive protein and blood culture done to assess the severity of infection.
Till the reports come,continue the same medication as it has good coverage for both gram negative and gram positive organism.Antibiotics may need to be changed according to the reports.
If pain abdomen is very severe,an USG abdomen may also be needed to rule out any surgical condition.

Thanks and regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (1 hour later)

Sorry Dr. XXXXXXX
I see my previous reply was incomplete
here is that one just after my last line in reply...

We consulted a different paediatric and he changed the antibiotics.
She has then given with Levofloaxacin+Ornidazol and Paracetamol 125mg+ mefnac acid for 3 days.
Fever went worst now and raised to 104+105F with stomach pain. Then as per Dr. advise we did following test.
MP(ICT), Hemoglobin, TLC, WBC, Typhoid.
Then she given Momocef O 100, Levofloaxacin, Dortin DS, P-250 & Serax Forte. This has been given 2doases now except P-250 which is being given in every 4-5 hrs. due to rise in temp.

please advise what to do?
How to control the high fever.
I am attaching the blood test report.

Thanks
XXXX

Answered by Dr. Pradeep Kumar Jain (5 hours later)

Brief Answer:
Try combination of mefenemic acid & paracetamol

Detailed Answer:
Hello

If fever is not responding to paracetamol given every 4 hours,adding mefenemic acid is a good choice.
Combination of mefenemic acid with paracetamol is available and you can give it after consulting your doctor for better results.

Thanks and regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (42 minutes later)

Thanks Dr.

After seeing the test report I attached earlier, what do you refer now?
I am going for a USG abdomen thought pain is not so severe but it lasted too long.
Can you suggest any medication or you would like to see USG report and continue the same medicines till then?
Do you still refer any other test?
FYI Urine test also be done and it was negative.

Thanks,
XXXXX

Answered by Dr. Pradeep Kumar Jain (54 minutes later)

Brief Answer:
Monitor the temperature for next 48 hrs

Detailed Answer:
Thanks for follow up

As she is getting the current treatment (monocef o and levofloxacin are good antibiotics for intestinal infection) for last 3 days only,I would like to monitor the temperature for next 48 hours with same medication and if fever continues in the same pattern or worsens further investigations like blood culture,c reactive protein and total wbc with differential count would be needed.
If reports suggest bacterial infection she may need injectable antibiotics.
You can go for USG abdomen although in most of the cases it comes normal if there is no associated bowel disturbances,vomiting or abdominal distension.
So I suggest you to observe for next 48 hours and if condition worsens consult your pediatrician immediately.

wishing for your child's speedy recovery.
regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pradeep Kumar Jain (11 hours later)

Hi Dr.
please find attached the test reports.
now the fever seems to be controlled, but stomach pain is still there. the last time fever measure was before 6 hrs. and it was around 100-101F.
She has given with 3 does of Monocef O and Levofloaxacin till time.
Please advise.

Thanks,
XXXXX

Answered by Dr. Pradeep Kumar Jain (9 hours later)

Brief Answer:
Reports are normal,continue same medication

Detailed Answer:
I have gone through the attached reports and all these reports are normal.
It's good to know that the frequency and spike of fever is now decreased.
Although combination of antibiotic should not be started in such cases but as fever is showing downgrading pattern after giving current medication,I would like to continue the same.
I wont get overly worried for pain as USG report is normal.Pain abdomen would also subside once the infection is controlled.

Wishing for your child's good health.
Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Pradeep Kumar Jain (2 days later)

Thanks dr. she is recovering now. But the little bit stomach pain is still there.

Answered by Dr. Pradeep Kumar Jain (11 hours later)

Brief Answer:
Don't worry,The pain will subside

Detailed Answer:
Thanks for the feedback

I won't get worried for mild abdominal pain if otherwise she is improving.Mild pain is common in typhoid and it get subsided within a week or two.
Give her healthy nutritious diet and continue medication for 14 days as advised.

Thanks and regards

Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar