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Fever she has she eat cefuroxime and pcm but fever not completely well what to add medicine

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Before I suggest anything, I need a bit more clinical context - recommending medicine changes without knowing details could be unsafe.
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How old is the patient? · How many days has the fever lasted despite cefuroxime + paracetamol? · Any other symptoms alongside the fever?

Before I suggest anything, I need a bit more clinical context - recommending medicine changes without knowing details could be unsafe.
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fever not responding to cefuroxime and paracetamol what to do next

I don't have details on the patient's age, how long the fever has lasted, or other symptoms, so I can't safely tell you to "add" a specific medicine, especially another antibiotic - that decision needs a doctor to examine the patient and possibly check blood counts, urine, malaria/dengue tests, or throat/chest exam to find out why the fever isn't settling. Adding drugs blindly (especially another antibiotic) can mask a diagnosis or cause harm.
What's safe to know right now:
  1. Paracetamol (PCM) alone often isn't enough for stubborn fever. A well-established approach (used in both textbooks and standard pediatric/adult practice) is to alternate paracetamol with ibuprofen:
    • Paracetamol every 6 hours + Ibuprofen every 8 hours, staggered, at the correct age/weight dose.
    • Ibuprofen should not be given if dengue is suspected (common in many regions with fever + antibiotic not working) because NSAIDs raise bleeding risk in dengue. This is exactly why you need a doctor's input first, not a self-added drug.
  2. Cefuroxime not controlling fever after 48-72 hours is a real medical signal, not just "give a stronger drug." Textbook guidance (Symptom to Diagnosis, Harrison's) is explicit: if fever persists beyond 48-72 hours of an appropriate antibiotic, the patient needs re-evaluation, not just a medicine swap - possible reasons include:
    • Wrong or resistant organism (bacteria not covered by cefuroxime)
    • A viral illness that antibiotics won't touch at all (e.g., dengue, flu, other viral fevers)
    • A separate/hidden source of infection (abscess, UTI, pneumonia not yet identified)
    • Wrong dose or poor drug absorption
  3. Red flags that mean go to a doctor/ER now, don't just add medicine at home:
    • Fever >39.4°C (103°F) not coming down with medicine
    • Fever lasting more than 3 days total
    • Rash, bleeding gums/nose, severe abdominal pain, persistent vomiting (dengue warning signs)
    • Lethargy, difficulty breathing, stiff neck, refusal to drink fluids, reduced urination
    • Any infant under 3 months with fever - always needs urgent medical review
My honest recommendation: Take her back to the prescribing doctor (or an urgent care/pediatrician if it's a child) now that cefuroxime + PCM over the expected course hasn't resolved the fever. They'll likely want to re-examine her, possibly run a CBC/malaria/dengue/urine test, and decide whether to change the antibiotic, add ibuprofen safely, or treat something antibiotics can't touch (a virus). Self-adding a second antibiotic or drug without that check-up risks masking the real cause.
If you can tell me her age, how many days the fever has lasted, and any other symptoms (rash, cough, vomiting, urination pain, travel history), I can give more specific, targeted guidance.

Adult 26 age and fever 102 and mpict widal negative

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adult fever 102 malaria negative widal negative not responding cefuroxime next steps dengue workup

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dengue diagnosis NS1 fever malaria negative

Malaria negative (MP/ICT) and Widal negative, with fever persisting despite cefuroxime + paracetamol in a 26-year-old, points away from typhoid and malaria and raises suspicion for a viral febrile illness (dengue being the most common in this pattern) or an organism cefuroxime doesn't cover. I can't tell you which drug to add without an exam and a few key tests - here's why, and what should happen next.
Why the picture doesn't fit "just add another antibiotic":
  • Widal negative is not very reassuring on its own - a single early Widal (especially in the first 5-7 days of fever) is often falsely negative; it needs a repeat test or paired titers, and blood culture is the actual gold standard for typhoid, not Widal.
  • MP/malaria negative (one smear/rapid test) also doesn't fully exclude malaria if parasitemia is low - but combined with a negative Widal and antibiotic failure, this pattern in most fever-endemic regions (India/South Asia especially) is classic for dengue or another viral fever, which antibiotics like cefuroxime simply do not treat at all.
  • Textbook guidance (Symptom to Diagnosis, Harrison's) is explicit: if fever persists beyond 48-72 hours on an appropriate antibiotic, the answer is re-evaluation and further testing, not empirically adding a second antibiotic - Symptom to Diagnosis, p. (line 7104-7106 of the referenced chapter).
What should actually be checked next (ask the doctor for these if not already done):
  1. CBC with platelet count and hematocrit - falling platelets/rising hematocrit strongly suggest dengue.
  2. Dengue NS1 antigen (positive from day 1-9 of fever) plus IgM/IgG if later in the illness - a 2025 systematic review confirms NS1 + IgM ELISA combined give the best pickup rate for acute dengue (Pillay et al., Lancet Microbe 2025, PMID 40209729).
  3. Blood culture (better than Widal for typhoid) if enteric fever is still suspected clinically.
  4. Repeat malaria smear/RDT if fever spikes continue, since a single negative test doesn't fully exclude it.
  5. CRP/urine routine to rule out an occult UTI or other bacterial source cefuroxime isn't covering.
In the meantime, what's reasonably safe:
  • Continue paracetamol for fever/comfort at proper dosing intervals.
  • Avoid ibuprofen, aspirin, or other NSAIDs until dengue is ruled out - these increase bleeding risk if it turns out to be dengue.
  • Keep well hydrated, monitor temperature and watch for warning signs: bleeding gums/nose, red spots/rash, severe abdominal pain, persistent vomiting, drowsiness, reduced urine output, or breathlessness - these need emergency care immediately, not home medicine adjustment.
Bottom line: this isn't a "swap or add one tablet" situation - a negative malaria and Widal with antibiotic failure needs the doctor to send dengue NS1/IgM and a CBC with platelets before deciding whether any drug (antibiotic or otherwise) should change. Take her back with these test requests; self-adding another antibiotic without knowing the actual cause could delay the right diagnosis or worsen things if it's dengue.

Can i change the cefuroxime and add another high antibiotic i am a dovtor suggest me

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typhoid fever antibiotic treatment ceftriaxone azithromycin

Since you're managing this clinically, here's the evidence-based reasoning for stepping up therapy - but the honest caveat first: neither Widal nor a single MP smear reliably excludes enteric fever or malaria, and if this turns out to be dengue or another viral fever, no antibiotic will help regardless of which one you pick. Ruling that out (dengue NS1/IgM, CBC with platelets, blood culture) before or alongside escalating is what actually changes outcome - empirically stacking antibiotics without a target organism just adds toxicity and resistance risk without benefit if it's viral.
Why cefuroxime may be underperforming: Cefuroxime (2nd-gen cephalosporin) has decent gram-positive/some gram-negative cover but weak activity against Salmonella typhi/paratyphi, atypicals, and many resistant Enterobacterales - it's not considered first-line for enteric fever or undifferentiated febrile illness (Katzung's, Scott-Brown's ENT Vol 1, p. 9079).
If clinical suspicion favors enteric fever (Widal negative doesn't rule this out - single early test is unreliable) or another gram-negative source, evidence-based options to switch/escalate to:
  1. Ceftriaxone (IV/IM, typically 1-2 g OD) - 3rd-gen cephalosporin, broader gram-negative cover, standard first-line for enteric fever. A 2022 Cochrane review found cephalosporins effective for enteric fever with no significant difference in failure/relapse versus azithromycin or fluoroquinolones (Kuehn et al., Cochrane 2022, PMID 36420914).
  2. Azithromycin (500 mg OD, oral) - a reasonable alternative/add-on, especially useful given rising fluoroquinolone resistance in South Asia; a 2024 systematic review of RCTs found oral azithromycin clinically comparable to ceftriaxone/fluoroquinolones for typhoid (Uzair et al., 2024, PMID 39623850), and Harrison's notes lower relapse rates with azithromycin versus fluoroquinolones or ceftriaxone.
  3. Fluoroquinolone (ciprofloxacin/ofloxacin) - only if local resistance data supports it; Salmonella Typhi resistance to fluoroquinolones is now high in many South Asian settings, so this is a weaker default choice unless you have local sensitivity data (Harrison's 22E, TREATMENT section).
  4. Avoid empiric carbapenem/very broad-spectrum escalation unless there's evidence of MDR enteric fever or sepsis/shock - reserve that tier for culture-confirmed resistant organisms (Harrison's 22E).
Before/while escalating, I'd strongly recommend:
  • Draw a blood culture before the next antibiotic dose if not already done - it's the actual gold standard for typhoid and will guide de-escalation.
  • Send dengue NS1 + IgM and a CBC with platelet/hematocrit trend - a 2025 meta-analysis (Pillay et al., Lancet Microbe, PMID 40209729) confirms NS1+IgM combined testing gives the best diagnostic yield for acute dengue, and this changes management entirely (supportive care only, no antibiotics, avoid NSAIDs).
  • Hold NSAIDs/aspirin until dengue is excluded given the bleeding risk.
If you already have culture or NS1 results pointing to a specific organism, tell me and I can narrow this down further. Without that, ceftriaxone +/- azithromycin is the reasonable evidence-supported empiric step up while confirmatory tests are pending.
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