Talk to General Physician on Fever And Cough For 1 Week(twice Tested Negative For Covid)
Asking For Someone else, Brother, Male, 31 Years old, Karachi
Fever of 102F since last Saturday night which came down to 100F with panadol. Covid test came negative on Monday and he started Cipro 500mg BD since Tuesday. Visited physician on Wednesday as fever and cough was not subsiding and he was feeling nauseous as well. Had one episode of vomiting. The doctor prescribed some labs and gave IV paracetamol, Dexa 4mg, flagyl, cefotaxime, omeprazole STAT. He was started on oral Azomax, softin and panadol. His labs show raised inflammatory markers(ferritin,LDH,ALT), leukopenia, borderline raised FBS(105mg/dl), urine DR is positive for ketones, protein and HB. He was tested again for COVID on Friday which came back negative today. Current symptoms are weakness and cough. No fever or vomiting. What should be the next course of action considering the deranged lab reports.
continue all the prescribed medications.
his xray chest should be done as soon as possible.
and keep him in isolation. atleast for 2weeks.
and do consult with any of us doctors for detailed checkup
Dr. Ayesha Khalil - Internal Medicine Specialist
MBBS, MSc (UK), MRCP (UK), SCE(Diab & Endo), FRCP (Lon), | Karachi
323 Positive Reviews
if he is still having fever, please get blood culture sensitivity done and MP ICT done. In addirion to chest X ray.
flagyl and ciprofloxacin are both inaporopriate to give in this scenario.
Patient
Post Owner
Chest X-ray was clear. No fever since Thursday, only mild cough. Done with Azomax orally for 5 days. Also done with IV course of cefotaxime, flagyl, bofalgan for 3 days as advised by physician. Still unclear about the cause of deranged labs though
5 years ago
Dr. Ayesha Khalil - Internal Medicine Specialist
MBBS, MSc (UK), MRCP (UK), SCE(Diab & Endo), FRCP (Lon), | Karachi
323 Positive Reviews
apart from azomax and bofalgan, all others were unnecessary (esp. flagyl and cefotax)
From the symptoms, especially raised ALT, he probably had enteric fever (commonly known as typhoid, though it is also be caused by ) It's the azomax which cured him as it is a good agent for resistant typhoid.
Typhoid is a clinical diagnosis, though it can be confirmed in 50 to 80 percent cases by blood culture.
Just explaining this so you have an answer to your question of a likely diagnosis.
Dr. Ayesha Khalil - Internal Medicine Specialist
MBBS, MSc (UK), MRCP (UK), SCE(Diab & Endo), FRCP (Lon), | Karachi
323 Positive Reviews
btw, ALT and LDH are not inflammatory markers. ALT suggests liver cell injury and LDH suggests any cell destruction, esp blood cells. His LDH was nothing to write home about.
Dr. Ayesha Khalil - Internal Medicine Specialist
MBBS, MSc (UK), MRCP (UK), SCE(Diab & Endo), FRCP (Lon), | Karachi
323 Positive Reviews
Stay blessed
Dr. Kashif Ijaz Ahmed - General Physician
MBBS, MRCP (UK), MRCP (E), MRGP (UK), FRSPH, CCT (UK), Family Medicine, PGDip (London), PGDip Diabetes (USW) | Lahore
42 Positive Reviews
hi
I don't have words to describe my feeling after reading this case this is classical darn example of absolute inappropriate use of antimicrobial thing I have failed to understand is it patient pressure or lack of confidence or inadequacy of knowledge that force us to adapt such prescribing me tell you a real case scenario in 2014 I prescribed ciprofloxacin to 3 patient and augmenting to 1 what to talk of 2016 I was sent an explanation to the idication of use n those patients and respective indications are patient with renal transplant presenting with UTI(where it was nephrologist Recommendation to start ciprofloxacin as first line), patient with mesingeal sponge kidney with recurrent cutis an resistant to trimethoprim nitro etc and a patient with suspected can imagine how closely such prescribing are monitored.
coming back to case
what made us to disbelieve that this is not just a simple viral know every URT I is not cover there are millions of different viruses to cause few days of untie like symptoms associated with fever with bloods very clearly reflective of lymphopenic response associated with transient tarasaminitis (again lot of viruses cause this )
why cant we just provide supportive care with simple reassurance plenty of fluids and paracetamol to help with fever.
DO WE NEED TO TRET EVERY URTI ASSOCIATED WITH FEVER WITH aZITHROMYCIN WHAT TO TALK OF OTHER TWO.
over inappropriate prescribing is dangerous and comes into patient clinician we must have some degree of sensitivity to this issue.
I feel so upset when I see such irrational prescribing habits.
I would with hold all abs and just encourage fluids and symptomatic care.A lot of illness need patience rather Abx
regards
Kashif
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Patient
Post Owner
Chest X-ray was done which came out clear
5 years ago