What causes high fever despite antibiotics in a 71-year-old?

Question

Hi doctor,

My father is 71 years old. He had a fever for a week, and the temperature raised up to 104 during the night along with frequent urination. Two days ago, the fever came down to 98.4 for five hours but again increased to 102.3 despite taking the same antibiotics. He is taking tablet Gudcef-CV 200 for five days and injection Monocef, twice a day for four days. His TLC was 18,000 last week. Please give your opinion.

Answer 1

Hi,

Welcome to icliniq.com.

I went through your post and investigation (attachment removed to protect patient identity).

Your father has sepsis, and the antibiotics are inadequate because both Gudcef (Cefpodoxime) and Monocef (Ceftriaxone) belong to the same group and have the same mechanism of action.

I would suggest him to take tablet Levofloxacin 500 mg, once a day and Gudcef-CV (Cefpodoxime and Clavulanic acid) 200, twice daily if he is not very ill or not having a breathing problem. Otherwise, hospitalization is the best. Repeating the RBC and the chest X-ray will help to see the progress. Consult your specialist doctor, discuss with him or her and take the medicines with their consent.

Regards.

For further queries consult an internal medicine physician online.

Answer 2

Hi,

Welcome back to icliniq.com.

The reason for high TLC (total leukocyte count) is the infection which is also supported by the fever.

He is receiving the antibiotics which are not according to the guidelines. I would give you some idea. In elderly, with a suspected infection, Monocef 1 g twice daily and Levofloxacin 500 mg once daily is started after sending the blood for culture, CBC (complete blood count), KFT (kidney function test), urine examination and urine culture. If the person does not improve after 72 hours, Monocef is stopped and a combination of injection Piperacillin and Tazobactam 4.5 g thrice a day is given.

Simultaneously, investigations are collected to see the culture. If the patient does not improve, or culture grows Staphylococcus, Pseudomonas, or Acinetobacter, the patient is hospitalized and treated. If you cannot hospitalize your father, at least start Piperacillin, Tazobactam, and Levofloxacin. Consult your specialist doctor, discuss with him or her and take the medicines with their consent.

Regards.

For further queries consult an internal medicine physician online.