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If your father is having continuous fever for seven days with negative blood reports then probably a detailed evaluation is required. Tablet Ofloxacin is a broad spectrum antibiotic against most bacterial infections and if his fever is not improving and blood culture and sensitivity is not showing any organism then probably he is having a parasitic infection or a viral infection. Antibiotics should be changed only after repeating blood culture and sensitivity and if there are organisms growing. This is to be discussed with complete clinical examination. Certain tests for infections like malaria and dengue might not show in initial reports and detailed repeat testing is necessary. Typhoid, which is a bacterial infection, is also elusive in early stages and antibody testing might help. Tablet Ofloxacin is a recommended medicine for typhoid and if tests confirm it then he might require a longer course. For blood sugar to control, he should get HbA1C (glycated hemoglobin test) test done once every 3 months to know the average blood glucose which he is having. During illness, he might be switched on to Insulin on sliding scale. This must be done carefully. Infections usually cause high levels of blood glucose in patients. His meal timings must also be maintained and a sample diet like the one given below might help. Early morning: A cup of tea or milk with 2 biscuits of his choice (no sugar), breakfast: Two parathas with curd or 2 plain rotis with paneer or two idlis with chutney or sambhar or 1 bowl of upma or oats, mid morning: Give him soup or a whole fruit either apple or guava, lunch: Salad with rotis (2 to 3) or rice (1 bowl) with dal or sambhar and a cup of vegetable. Occasionally, you can add some light fries in lunch. You can add two vegetables every day, evening: tea or juice with 2 biscuits without sugar, and dinner should be same as in lunch with slight variation. Dinner should be lighter than lunch. You can give one glass of milk without sugar just before going to bed. You might hold the decision to give tablet Glycomet-GP 3 (combination of Glimepiride and Metformin) after observing his blood sugar for two to three days at night before dinner. Anyway, he is on Insulin and tablet Metformin 500 mg at night and this should be able to control the blood glucose to certain extent. Stress him on having a regular diet plan. You have not mentioned any thing about his diet and it is suggested that he follows a strict diabetic diet given above and his blood sugar is monitored at the same time every day. In conclusion, please have a discussion with his treating doctor and get any specific tests done to confirm a suspected clinical diagnosis. Any change in antibiotics can be done only after close clinical evaluation. I hope you have done complete blood count and peripheral blood smear. Doing other basic investigations like chest x- ray and ultrasound scan abdomen might also help. I hope this helps. Thank you and take care. Regards.
The Probable causes:
The probable cause is a parasitic, viral, or occult bacterial infection.Investigations to be done:
1. Please have a discussion with his treating doctor and get any specific tests done to confirm a suspected clinical diagnosis.Treatment plan:
2. Any change in antibiotics can be done only after close clinical evaluation.
3. Get a complete blood count and peripheral blood smear done.
4. Chest x- ray.
5. Ultrasound scan of abdomen.
1. Confirm the diagnosis of fever with specific tests.Regarding follow up:
2. Antibiotics to be changed after isolating organism and doing culture and sensitivity.
3. Diet should be strictly followed.
4. Close monitoring of blood glucose level to be done at specific time every day.
Revert back after investigations to a general practitioner online.