Symptomatic treatment fever

An antibody directed at the murine epitope of infliximab may develop in patients. A delayed infusion reaction, which occurs 1-2 weeks after infusion, develops in approximately 5% patients who are re-treated with infliximab. Delayed infusion reaction is more common in patients with circulating anti-infliximab antibodies (20-30% of those getting multiple infusions) than in those without the antibodies. These reactions consist of myalgia arthralgia fever rash urticaria and facial, hand, and lip edema. Delayed reactions respond to symptomatic treatment with antihistamines or corticosteroids. Positive antinuclear antibodies (ANA) and anti-dsDNA develop in a small number of patients. Development of a lupus-like syndrome has been reported that resolved after discontinuation of the drug. 

A 62-year-old diabetic man on stable oral medication with glibenclamide, metformin, Zestoretic (lisino-pril + hydrochlorothiazide), gemfibrozil, and aspirin developed febrile generalized pustular eruptions after 44 days of therapy with oral terbinafine 250 mg/day (50). Withdrawal of terbinafine and symptomatic treatment with hydrotherapy and topical and systemic steroids resulted in complete resolution of fever and pustulosis within 4 days. The erythematous component responded more slowly, and mildly pruritic erythematous plaques persisted for more than 40 days. 

FIGURE 36-1. Recommendations for treating acute diarrhea. Foiiow these steps (1) Perform a compiete history and physicai examination. (2) is the diarrhea acute or chronic if chronic diarrhea, go to Fig. 36-2. (3) if acute diarrhea, check for fever and/or systemic signs and symptoms (i.e., toxic patient), if systemic illness (fever, anorexia, or volume depletion), check for an infectious source. If positive for infectious diarrhea, use appropriate antibiotic/anthelmintic drug and symptomatic therapy. If negative for infectious cause, use only symptomatic treatment. (4) If no systemic findings, then use symptomatic therapy based on severity of volume depletion, oral or parenteral fluid/electrolytes, an-tidiarrheal agents (see Table 36-4), and diet. 

Most patients with acute diarrhea experience mild to moderate distress. In the absence of moderate to severe dehydration, high fever, and blood or mucus in the stool, this illness is usually self-limiting within 3 to 7 days. Mild to moderate acute diarrhea is usually managed on an outpatient basis with oral rehydration, symptomatic treatment, and diet. Elderly persons with chronic illness and infants may require hospitalization for parenteral rehydration and close monitoring. 

A 51-year-old woman with metastatic breast cancer started treatment with capeeitabine 2500 mg/m daily for 14 days every 21 days. Treatment was stopped after 8 days because she developed diarrhoea, vomiting and hand-foot syndrome. She improved with parenteral hydration and symptomatic treatment, but 3 weeks later still had diarrhoea, leg oedema and hand-foot syndrome. She was found to have been taking folic acid 15 mg daily for several weeks before starting capecitabine and had continued to take it during and after capecitabine treatment. The patient s condition improved when the folie acid was stopped, but she then developed diarrhoea and fever followed by necrotic colitis and she died from septic shock and vascular collapse. It is possible that the concurrent use of folic acid enhanced the toxicity of capecitabine. ... 

The treatment of acute bronchitis is symptomatic and supportive in nature. Reassurance and antipyretics alone are often sufficient. Bedrest and mild analgesic-antipyretic therapy are often helpful in relieving the associated lethargy, malaise, and fever. Patients should be encouraged to drink fluids to prevent dehydration and possibly decrease the viscosity of respiratory secretions. 

Apart from disease entities, one recognizes a variety of symptoms that makes up a disease, like pain, fever, convulsions, cough, rhinitis, nausea, meteorism, diarrhea, headache, dyspnea, anorexia, insomnia, constipation, etc. All these symptoms could make up a symptom complex or syndrome, or may stand alone by themselves without being part of a disease entity. The term of symptomatic drug treatment usually refers to its use for the alleviation of symptoms, whether as a part of a syndrome or standing alone. 

Docosanol cream is approved for the over-the-counter treatment of herpes labiaUs. It shortens the duration of symptoms of cold sores and fever blisters but does not provide symptomatic relief. 

A flu-like illness, with fever, headache, malaise, and bone pain, can occur shortly after the administration of rifampicin, and was observed in a man who had taken rifampicin 600 mg monthly for multibacillary leprosy (10). However, the reaction usually occurs with higher doses given weekly or twice weekly. The usual procedure is to reduce the dose or increase the frequency of treatment. Antipyretic drugs can be used to provide symptomatic relief. 

Most antihistamines have anticholinergic atropine-like actions and cause a dry mouth and similar side-effects. The clinical uses of H, antihistamines are extensive, particularly for the symptomatic relief of allergy, such as hay fever and urticaria, and (together with corticosteroids) in the acute treatment of anaphylactic shock. Many antihistamines also have antinauseant properties and are used, for instance, to prevent travel sickness (though this property may well result from their anticholinergic actions). The older antihistamines produce drowsiness and this sedative action may be used to help sleep (e.g. promethazine). 

Corticosteroids — Beclomethasone dipropionate (17) aerosol has been tested extensively clinically. It is used prophylactically (400 fig per day), not therapeutically, in the treatment of chronic asthma, particularly in children.52 An evaluation of the drug has been published.53 One of the most important clinical advantages is that 1 7 effectively can replace oral corticosteroids in steroid-dependent patients and avoid many of the adverse effects of adrenal suppression.52,54 Most patients with impaired adrenal function due to oral corticosteroids show recovery of adrenal function within 6 months.55 The combination of 17 and disodium cromoglycate (DSCG) showed no additive therapeutic effects.5 Flunisolide (18), when administered as a nasal spray for 4 weeks during the hay fever season in 51 patients, showed significant symptomatic improvement with no systemic steroid effects observed.57... 

Patients with indwelling catheters acquire UTIs at a rate of 5% per day. The closed systems are capable of preventing bacteri-uria in most patients for up to 10 days with appropriate care. After 30 days of catheterization, however, there is a 78% to 95% incidence of bacteriuria despite use of a closed system. Unfortunately, UTI symptoms in catheterized patient are not clearly defined. Fever, peripheral leukocytosis, and urinary signs and symptoms may be of little predictive value. When bacteriuria occurs in the asymptomatic, short-term catheterized patient (<30 days), the use of systemic antibiotics should be withheld and the catheter removed as soon as possible. If the patient becomes symptomatic, the catheter should be removed and treatment as described for complicated infections started. The optimal duration of therapy is not known. In the long-term catheterized patient (>30 days), bacteriuria is inevitable. The administration of... 

Mild side effects consisting of headache, myalgias, and low-grade fever 1 to 2 weeks after vaccination occur in fewer than 10% of vaccinees treatment should be symptomatic. Immediate hypersensitivity reactions are rare and occur primarily in persons who have... 

A diagnosis of acute viral hepatitis type A was made, probably contracted from virus-contaminated food Percy had eaten while on his cruise. His physician explained that there was no specific treatment for type A viral hepatitis but recommended symptomatic and supportive care and prevention of transmission to others by the fecal-oral route. Percy took acetaminophen 3 to 4 times a day for fever and arthralgias throughout his illness. 

Priese subsequently reported on the treatment of 60 women with postpartal mastitis with Echinacin i.v. [36]. The symptomatic response to Echinacin (shivering, fever) was the same as that observed by Roseler [33, 34] and Moell [35], though in Priese s study, the response rate was over 90%. An important aspect raised by Priese was that the dose used was 0.1-1.0 ml for an average of six days, but that higher doses were not used because above 1 ml i.v. an inhibition of defence reactions occurred . This would appear to concur with the later in vitro data of others that very high concentrations of E. purpurea extract are inhibitory to lymphocyte proliferation [37]. 

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