Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management and investigations for a patient with fever lasting two days:
- Perform a thorough clinical assessment to identify any immediately life-threatening features such as compromised airway, breathing, circulation, or decreased consciousness, and consider sepsis as a differential diagnosis 1.
- Use the NICE traffic light system to assess the risk of serious illness based on symptoms and signs 3.
- If the patient is a child under 5 years, assess for specific signs of serious infections such as meningitis, pneumonia, urinary tract infection (UTI), septic arthritis, osteomyelitis, or Kawasaki disease, especially if fever persists beyond 5 days 1,3.
- For infants under 3 months, perform investigations including full blood count, blood culture, C-reactive protein, urine testing for UTI, chest X-ray if respiratory signs are present, and stool culture if diarrhoea is present 1.
- Consider lumbar puncture in infants younger than 1 month, or 1 to 3 months if unwell or with abnormal white blood cell counts 1.
- In children older than 3 months with fever without apparent source, consider observation in hospital to differentiate serious from non-serious illness 1.
- Do not routinely prescribe oral antibiotics without an apparent source of infection 1,2.
- Advise on symptomatic management with antipyretics such as paracetamol or ibuprofen to reduce distress, but do not rely on temperature reduction after antipyretics to differentiate serious illness 2.
- Advise on self-care measures including adequate fluid intake and appropriate clothing to prevent dehydration and discomfort 2.
- If red features (signs of serious or life-threatening illness) are present, arrange emergency hospital transfer 3.
- If amber features are present, arrange urgent face-to-face assessment to guide further management 3.
- If green features only, the patient can usually be managed at home with safety-netting advice and follow-up as needed 3.