Medical Journal of Dr. D.Y. Patil Vidyapeeth

COMMENTARY
Year
: 2016  |  Volume : 9  |  Issue : 1  |  Page : 30-

Short duration fever: Challenge of antibiotic use


Viroj Wiwanitkit 
 Tropical Medicine Unit and Editorial Director Center, Hainan Medical University, Hainan, China; Dr. D.Y. Patil Medical University, Pune, Maharashtra, India; Department of Medicine, Faculty of Medicine, University of Nis, Nis, Serbia; Department of Biological Science, Joseph Ayo Babalola University, Nigeria; Public Health Curriculum, Surin Rajabhat University, Surin, Thailand

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok - 10160




How to cite this article:
Wiwanitkit V. Short duration fever: Challenge of antibiotic use.Med J DY Patil Univ 2016;9:30-30


How to cite this URL:
Wiwanitkit V. Short duration fever: Challenge of antibiotic use. Med J DY Patil Univ [serial online] 2016 [cited 2020 Sep 20 ];9:30-30
Available from: http://www.mjdrdypu.org/text.asp?2016/9/1/30/172423


Full Text

A report in the present volume of this journal, clinical, serological, microbiological, and outcome study of 200 cases of short duration fever without prior exposure to antibiotic is very interesting. [1] The short duration fever is a very common problem seen in primary care clinic. The primary physicians have to manage this problem daily in their clinical practice. As a rule in medicine, the early diagnosis and prompt treatment are required. However, to make a definitive diagnosis for short duration fever is sometimes difficult for the primary physicians. Sometimes, the clinical diagnosis has to be used. To know the epidemiology of etiologies of the short duration fever is very useful. In the article, "common etiology for fever was found to be nonspecific viral fever (45%), which did not need antibiotics, then dengue fever (26.5%), enteric fever (7%), and malaria with Plasmodium vivax (4%) predominance. [1]" Nevertheless, the etiologies of fever can be different from site to site. For sure, the present report is from South Asia. The pattern will be significantly different in other regions of the world. The tropical infections such as malaria should be uncommon in the report from the nontropical zones. Susilawati and McBride noted that "use of general diagnostic tools for infectious diseases might reduce the proportion of acute undifferentiated fever cases. [2]" However, the problem of "cost" and "availability" has to be managed. As already mentioned, the important problem is the lack of facilities to make a definitive diagnosis. In the poor developing countries, the "frequencies of undiagnosed cases ranged from 8% to 80%. [2]" In addition, the waiting turnaround period to get the laboratory result can be very long, and this cannot be useful for decision making for treatment.

Since the early diagnosis is usually not possible, the choice of the appropriate treatment will become problematic. The use of antibiotic is usually a big challenge. Rational use of antibiotic is usually a focus in clinical pharmacology. The use of antibiotic for the management of acute febrile illness case is usually a dilemma. As noted by Harrison and Ouyang, "the decision to initiate empiric treatment needs to be made before the definitive diagnosis is known. [3]" The use of antibiotic without definitive diagnosis might sometimes be useless, but it can sometimes be useful. In the recent report by Wijesinghe et al., the delayed antibiotic use in case of concurrent dengue and leptospirosis infections can be seen and can lead to increase mortality. [4] Wijesinghe et al. noted that "leptospirosis, being a condition having definitive antibiotic therapy, should always be ruled out even if the patient is positive for dengue serology in regions endemic to both these diseases as early initiation of antibiotic therapy can reduce mortality significantly. [4]" How to make a clinical decision to treat the patient with acute febrile illness is an actual state-of-art that each physician has to learn and improve his/her clinical acumen.

References

1Satpathy PK, Wasekar MS, Diggikar PM, Misra RN, Patil A, Zagde P. Clinical, serological, microbiological and outcome study of 200 cases of short duration fever without prior exposure to antibiotic. Med J DY Patil Univ 2016;9:24-30.
2Susilawati TN, McBride WJ. Acute undifferentiated fever in Asia: a review of the literature. Southeast Asian J Trop Med Public Health 2014;45:719-26.
3Harrison RF, Ouyang H. Fever and the rational use of antimicrobials in the emergency department. Emerg Med Clin North Am 2013;31:945-68.
4Wijesinghe A, Gnanapragash N, Ranasinghe G, Ragunathan MK. Fatal co-infection with leptospirosis and dengue in a Sri Lankan male. BMC Res Notes 2015;8:348.