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Continue 15 days tab pcm and antibiotics dose given ..what is side effects and still fever wasn't a down

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causes of fever not responding after 15 days antibiotics paracetamol persistent fever workup

What's likely going on

Fifteen days of paracetamol (PCM) plus antibiotics with fever still not settling is a red flag for treatment failure and needs re-evaluation, not just continuation of the same drugs. Common reasons this happens:
1. Wrong diagnosis / wrong bug
  • The antibiotic may not cover the actual organism (resistant bacteria, or the illness is viral, fungal, or parasitic - e.g., dengue, malaria, typhoid, TB - none of which respond to standard antibiotics).
  • An undrained focus of infection (abscess, empyema, infected collection) won't clear with antibiotics alone - needs drainage/imaging (ultrasound/CT).
2. Drug fever itself Ironically, antibiotics are the single most common cause of "drug fever" - a fever caused by the medication itself via a hypersensitivity reaction, usually appearing after about 7-10 days of a drug and not responding to more antibiotics. Clue: patient looks relatively well despite the fever, may have a rash or eosinophilia, and fever resolves once the offending drug is stopped - Tintinalli's Emergency Medicine, Harrison's Principles of Internal Medicine 22E.
3. Resistant organism or subtherapeutic dosing - inadequate dose/duration or resistance to the chosen antibiotic.
4. Non-infectious causes - autoimmune/inflammatory disease, malignancy (lymphoma), or other causes masquerading as infection - part of the classic "fever of unknown origin" workup when fever persists beyond 1-2 weeks despite treatment.

Side effects to watch for

Paracetamol (PCM), taken daily for 15 days:
  • Main concern is hepatotoxicity (liver damage) - dose-related, worse if underlying liver disease, malnutrition, or alcohol use. Watch for right upper abdominal pain, yellowing of eyes/skin, dark urine, unusual tiredness, nausea - P C Dikshit Textbook of Forensic Medicine and Toxicology, Sleisenger and Fordtran's Gastrointestinal and Liver Disease.
  • Rare: skin reactions, blood count changes.
  • Total daily dose should stay within safe limits (generally not exceeding ~3g/day in adults without medical supervision, less in children - your doctor should confirm the exact dose for the patient's weight/age).
Antibiotics (side effects depend on which one specifically - let me know the name for precise advice), but common ones across classes include:
  • GI upset - nausea, diarrhea, antibiotic-associated colitis
  • Allergic reactions - rash, itching, in rare cases anaphylaxis
  • Fungal overgrowth (oral thrush, vaginal candidiasis) from prolonged use
  • Class-specific risks: e.g., fluoroquinolones (tendon problems), aminoglycosides (kidney/ear toxicity), some drugs cause photosensitivity or drug fever itself as noted above.
  • Prolonged antibiotic courses (15 days) also raise concern for disrupted gut flora and antibiotic resistance if not clinically indicated for that long.

What to do now

This is a case that needs a doctor to re-examine in person, not just continue the same medicines blindly for two weeks with no improvement. Typically the next steps would be:
  • Stop and reassess rather than blindly extend the same antibiotic
  • Basic workup: CBC, blood cultures, urine routine/culture, chest X-ray, malaria/typhoid/dengue tests depending on region and exposure, liver function tests (especially given 15 days of paracetamol)
  • If no source found, consider imaging (ultrasound/CT) to look for a hidden abscess or collection
  • Consider drug fever as a diagnosis of exclusion if the patient otherwise looks well
I don't have the specific antibiotic name, patient's age, or other symptoms (rash, pain, cough, urinary symptoms, travel history) in this conversation - if you share those, I can narrow down the likely cause and specific side-effect profile much more precisely. Persistent fever beyond 5-7 days despite appropriate treatment generally warrants going back to the treating doctor promptly rather than continuing the same regimen further.
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