Priscription for fever in opd
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OPD fever prescription paracetamol ibuprofen dosage adult standard treatment
Here is a standard OPD Prescription for Fever (Pyrexia) for an adult patient:
OPD Prescription - Fever (Pyrexia)
Patient Assessment First
Before prescribing, assess:
- Temperature (low-grade: 99-100.4°F / high-grade: >101°F)
- Duration of fever
- Associated symptoms (chills, body ache, cough, dysuria, rash, etc.)
- Red flags: rash, neck stiffness, altered sensorium, bleeding spots
Rx (Standard Adult OPD Prescription)
| # | Drug | Dose | Route | Frequency | Duration | Instructions |
|---|---|---|---|---|---|---|
| 1 | Tab. Paracetamol 500mg | 1-2 tabs | Oral | Every 6-8 hrs (SOS) | 3-5 days | Take after food. Do not exceed 4g/day |
| 2 | Tab. Ibuprofen 400mg | 1 tab | Oral | Every 8 hrs (if needed) | 3 days | Take with food. Avoid if GI issues |
| 3 | Tab. Cetirizine 10mg | 1 tab | Oral | Once at night | 3-5 days | For associated allergic symptoms / cold |
| 4 | ORS / Electrolyte | 1 sachet in 1L water | Oral | 2-3 times/day | 3-5 days | To prevent dehydration |
Supportive Advice (Non-Pharmacological)
- Tepid sponging with lukewarm water (not cold) for high-grade fever
- Plenty of oral fluids (water, coconut water, ORS, juices)
- Light, nutritious diet - avoid oily/spicy food
- Rest - avoid physical exertion
- Wear light, loose-fitting clothing
Specific Fever Causes - Additional Drugs
If a specific cause is suspected, add:
| Suspected Cause | Additional Drug |
|---|---|
| Viral fever | Symptomatic only (above Rx is sufficient) |
| Malaria (endemic area / travel history) | Tab. Artemether-Lumefantrine (AL) as per weight-based dosing; refer for blood smear/RDT first |
| Typhoid | Tab. Azithromycin 500mg OD x 7 days OR Tab. Cefixime 200mg BD x 14 days |
| UTI with fever | Tab. Nitrofurantoin 100mg BD OR Ciprofloxacin 500mg BD x 5-7 days |
| Bacterial URTI | Tab. Amoxicillin 500mg TDS x 5-7 days (if bacterial confirmed) |
Investigations (if fever >3 days or no obvious cause)
- CBC (look for leucocytosis, thrombocytopenia)
- Peripheral blood smear (malaria)
- Widal test (typhoid)
- Dengue NS1 Ag + IgM/IgG (if dengue suspected)
- Urine R/M (if UTI suspected)
- CRP / ESR (if systemic infection suspected)
Red Flags - Refer to Higher Centre / Emergency
- Fever >104°F (40°C) not responding to antipyretics
- Febrile seizures
- Petechial rash / bleeding (suspect dengue hemorrhagic fever)
- Neck stiffness / photophobia (suspect meningitis)
- Altered consciousness
- Hypotension / signs of shock
- Immunocompromised patient (HIV, chemotherapy, diabetes)
- Fever persisting >7 days without diagnosis
Key Prescribing Notes
- Paracetamol is the first-line antipyretic - safe, well-tolerated
- Avoid aspirin in children/adolescents (risk of Reye's syndrome)
- Avoid NSAIDs (ibuprofen) in dengue suspected cases - risk of bleeding
- Do not prescribe antibiotics for uncomplicated viral fever without evidence of bacterial infection
- Reassess if fever does not subside in 48-72 hours
Disclaimer: This is a general clinical reference. Always tailor the prescription to the individual patient's history, allergies, comorbidities, local drug resistance patterns, and clinical findings. Confirm diagnosis before adding specific antimicrobials.
Cough cold fever
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Here is a complete OPD Prescription for Cough + Cold + Fever (URTI / Viral Fever) for an adult patient:
OPD Prescription - Cough, Cold & Fever (Upper Respiratory Tract Infection)
Probable Diagnosis: Acute Viral URTI / Common Cold with Fever
Rx (Standard Adult Prescription)
| # | Drug | Dose | Route | Frequency | Duration | Instructions |
|---|---|---|---|---|---|---|
| 1 | Tab. Paracetamol 500mg | 1-2 tabs | Oral | Every 6 hrs (SOS) | 5 days | For fever & body ache. Max 4g/day |
| 2 | Tab. Cetirizine 10mg (antihistamine) | 1 tab | Oral | Once at night (HS) | 5 days | For runny nose, sneezing, watery eyes |
| 3 | Tab. Phenylephrine 10mg (decongestant) OR Pseudoephedrine 60mg | 1 tab | Oral | BD (twice daily) | 3-5 days | For nasal congestion. Avoid in hypertension |
| 4 | Syp. / Tab. Dextromethorphan 15mg (cough suppressant) | 1 tab / 10ml syrup | Oral | TDS | 3-5 days | For dry, irritating cough |
| 5 | Tab. Ambroxol 30mg (mucolytic/expectorant) | 1 tab | Oral | TDS | 5 days | For productive cough with mucus |
| 6 | Steam Inhalation | - | Inhalation | 2-3 times/day | 5 days | Add menthol/Vicks if available |
Common Combination OTC options available in India:
- Tab. Sinarest / Coldact / D-Cold Total - contain Paracetamol + Phenylephrine + Chlorphenamine (CPM)
- Syp. Ascoril / Grilinctus / Benadryl - contain Dextromethorphan or Guaifenesin ± antihistamine
Throat Involvement (Pharyngitis / Sore Throat)
| # | Drug | Dose | Frequency | Duration |
|---|---|---|---|---|
| Tab. Benzydamine gargle | 1 diluted rinse | 3-4 times/day | 5 days | |
| OR Lozenges (Strepsils / Betadine) | 1 lozenge | Every 3-4 hrs | 5 days |
If Bacterial Superinfection is Suspected
(Purulent nasal/throat discharge, high-grade fever >3 days, toxic appearance)
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Tab. Amoxicillin 500mg | 1 tab | TDS | 5-7 days |
| OR Tab. Azithromycin 500mg | 1 tab | OD | 3-5 days |
| OR Tab. Co-Amoxiclav 625mg (if sinusitis/tonsillitis suspected) | 1 tab | BD | 5-7 days |
Do NOT prescribe antibiotics for uncomplicated viral URTI - antibiotic use is contraindicated in routine common cold (Textbook of Family Medicine, 9e)
Supportive / Non-Pharmacological Advice
- Warm saline gargles - 1/2 tsp salt in warm water, 3-4 times daily (excellent for sore throat)
- Steam inhalation with or without menthol, 2-3 times/day
- Saline nasal drops / spray - for nasal congestion (safe, no rebound)
- Honey + warm water / ginger tea - soothing for cough
- Increase oral fluid intake - warm soups, water, herbal teas
- Rest adequately
- Avoid cold beverages, ice cream, cold exposure
- Cover nose and mouth when sneezing/coughing (infection control)
Investigations (Usually Not Needed for Simple URTI)
Order only if:
- Fever >3-5 days without improvement
- High-grade fever, toxic appearance
- Suspected influenza, COVID-19, strep throat, sinusitis
| Investigation | Purpose |
|---|---|
| CBC | Leucocytosis (bacterial) vs normal/low (viral) |
| Throat swab culture | If strep pharyngitis suspected |
| Rapid Influenza Antigen / COVID-19 RAT | If epidemic season |
| X-Ray PNS / Chest X-Ray | If sinusitis / pneumonia suspected |
Red Flags - Refer / Escalate
- Dyspnoea / breathlessness / SpO2 <94%
- High fever >104°F not responding to antipyretics
- Severe throat pain with drooling / stridor (suspect epiglottitis / peritonsillar abscess)
- Ear pain with discharge (otitis media)
- Altered sensorium / neck stiffness
- Symptoms persisting or worsening beyond 7-10 days
Follow-up
- Review in 3-5 days if no improvement
- Return immediately if breathlessness or high-grade fever develops
Key Point: The majority of cough-cold-fever presentations in OPD are viral and self-limiting (7-10 days). Treatment is primarily symptomatic. Antibiotics are not indicated unless bacterial infection is confirmed or strongly suspected. - Textbook of Family Medicine, 9e
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