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Fever Without a Focus Medication

  • Author: Saul R Hymes, MD, FAAP; Chief Editor: Russell W Steele, MD  more...
Updated: Dec 31, 2014

Medication Summary

Treatment with antipyretics is somewhat controversial because fever is a defensive response to infection (Sullivan, 2011). Base the decision to treat a fever without a focus on age, presentation, and laboratory results. If antibiotics are administered empirically, close follow-up is required. Parenteral antibiotics are the drugs of choice.



Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover likely pathogens in the clinical setting.

Ceftriaxone (Rocephin)


Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms; arrests bacterial growth by binding to one or more penicillin-binding proteins.

Cefotaxime (Claforan)


For septicemia and treatment of gynecologic infections caused by susceptible organisms. Arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth. Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms. Useful in pediatric infections as an alternative to ceftriaxone in infants in the first month or two of life, in whom bilirubin displacement from protein-binding sites by the latter antibiotic may be harmful.

Ampicillin/sulbactam (Unasyn)


Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.


Antipyretic agents

Class Summary

These agents inhibit central synthesis and release of prostaglandins that mediate the effect of endogenous pyrogens in the hypothalamus and, thus, promote the return of the set-point temperature to normal.

Ibuprofen (Advil, Motrin)


Among the few NSAIDs indicated for reduction of fever; produces anti-inflammatory, antipyretic, and analgesic effects by inhibiting prostaglandin synthesis.

Acetaminophen (Tempra, Tylenol)


Reduces fever by acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

Contributor Information and Disclosures

Saul R Hymes, MD, FAAP Director, Pediatric Lyme and Tick-Borne Diseases Center, Department of Pediatrics, Division of Pediatric Infectious Diseases, Stony Brook Children’s Hospital; Assistant Professor of Clinical Pediatrics, Department of Pediatrics, Division of Pediatric Infectious Diseases, Stony Brook University School of Medicine

Saul R Hymes, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Ashir Kumar, MD, MBBS FAAP, Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS is a member of the following medical societies: Infectious Diseases Society of America, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

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Table. Summary of the Yale Observation Scale
Observation Items 1 (Normal) 3 (Moderate Impairment) 5 (Severe Impairment)
Quality of cry Strong with normal tone or contentment without crying Whimpering or sobbing Weak cry, moaning, or high-pitched cry
Reaction to parent stimulation Brief crying that stops or contentment without crying Intermittent crying Continual crying or limited response
Color Pink Acrocyanotic or pale extremities Pale or cyanotic or mottled or ashen
State variation If awake, stays awake; if asleep, wakes up quickly upon stimulation Eyes closed briefly while awake or awake with prolonged stimulation Falls asleep or will not arouse
Hydration Skin normal, eyes normal, and mucous membranes moist Skin and eyes normal and mouth slightly dry Skin doughy or tented, dry mucous membranes, and/or sunken eyes
Response (eg, talk, smile) to social overtures Smiling or alert (< 2 mo) Briefly smiling or alert briefly (< 2 mo) Unsmiling anxious face or dull, expressionless, or not alert (< 2 mo)
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