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Fever and Symptoms and the Host Pathogen relationship

Fever handout

Mandatory reading: fever-and-survival

One of the students pointed out that fever seems to work in synergy with mechanisms that reduce the availability of free iron. Iron sequestration is important in reducing bacterial growth. Fever + reduced iron =reduced bacterial growth. Optional Reading about this topic:

Fever and Reduced Iron

Writing project for next week:

A mother brings her 8 month old infant girl with a temperature of 100 F to the Emergency Room. You are the doctor and you examine the infant and diagnose her with an upper respiratory infection (the common cold).  You tell the mother the child has a viral infection that will get better on its own.  Mom insists that you prescribe antibiotics. She also wants you to prescribe something for the fever. And she wants a decongestant.

Will you recommend antibiotics for the child? Why or why not?

You refuse to prescribe cough and decongestant medicine for the child because of this report:

Tylenol is not thought to be as harmful as cough and decongestant medicine in this age group. Should you prescribe children’s tylenol for the fever? Why or why not?; Remember, there is no incorrect answer for this.


A brief note on treating childhood diarrhea with anti-diarrheal medications: This report exerpted from from Alam and Ashraf Paediatr Drugs. 2003;5(3):151-65 concludes that the drugs most commonly used for diarrhea diphenoxylate (lomotil) and loperamide should be avoided in young children:

“5.2 Antimotility Drugs
The antimotility category of drugs includes the synthetic opiates, such as diphenoxylate and loperamide. The mechanism of action of these opiates is to reduce stool output, primarily by affecting intestinal motility.
Although diphenoxylate is effective in relieving symptoms of mild chronic diarrhea in adults, there is no clear evidence of its usefulness in acute diarrhea in children or adults.[41] There is evidence that the antimotility effects of diphenoxylate may actually worsen bacillary dysentery.[42] Potentially fatal adverse effects of diphenoxylate on the central nervous system are not uncommon;[43,44] therefore, there is no role for diphenoxylate in the treatment of childhood diarrhea.
Loperamide has not been shown to reduce losses of fluid and electrolytes in acute diarrhea.[45] The drug may have a modest effect on the duration of diarrhea,[45] probably as a result of reduced gas- trointestinal motility; however, this effect is dose-dependent[46,47] and of questionable clinical importance. Abdominal distension and potentially fatal paralytic ileus have been reported in infants and young children treated with loperamide.[48-50] Toxic effects on the central nervous system have most commonly been observed in children <6 months of age. In conclusion, loperamide has no place in the routine management of diarrhea in children.”

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Joe Alcock

Emergency Physician, Educator, Researcher, interested in the microbiome, evolution, and medicine

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