Green Robin, Webb David, Jeena Prakash Mohan, Wells Mike, Butt Nadia, Hangoma Jimmy Mapenzi, Moodley Rajatheran Sham, Maimin Jackie, Wibbelink Margreet, Mustafa Fatima
Department Paediatrics and Child Health, University of Pretoria, South Africa.
Houghton House Group, Johannesburg, South Africa.
Afr J Emerg Med. 2021 Jun;11(2):283-296. doi: 10.1016/j.afjem.2020.11.004. Epub 2021 Apr 10.
Fever is one of the most common reasons for unwell children presenting to pharmacists and primary healthcare practitioners. Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region. This multidisciplinary consensus guide was developed to assist pharmacists and primary healthcare workers in sub-Saharan Africa to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers. Fever is defined as body temperature ≥ 37.5 °C and is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine level of distress and to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home. In children with warning signs, serious causes of fever that may need to be excluded include infections (including malaria), non-infective inflammatory conditions and malignancy. Simple febrile convulsions are not in themselves harmful, and are not necessarily indicative of serious infection. In the absence of illness requiring specific treatment, relief from distress is the primary indication for prescribing pharmacotherapy, and antipyretics should not be administered with the sole intention of reducing body temperature. Care must be taken not to overdose medications and clear instructions should be given to parents/caregivers on managing the child at home and when to seek further medical care.
发热是身体不适的儿童前往药剂师和基层医疗从业者处就诊的最常见原因之一。目前，撒哈拉以南非洲地区没有专门针对社区和基层医疗工作者的发热评估与管理指南。本多学科共识指南旨在协助撒哈拉以南非洲地区的药剂师和基层医疗工作者对发热儿童进行风险分层和管理，决定何时转诊，以及如何向家长和照料者提供建议。发热定义为体温≥37.5°C，是对疾病的一种正常生理反应，有助于并加速康复。虽然发热常与自限性疾病相关，但它引起了家长和在场医护人员的极大关注。药房工作人员和基层医疗工作者可利用临床体征来确定患儿的痛苦程度，区分出发热且有严重疾病高风险、需要特定治疗、住院或专科护理的儿童，以及风险较低、可在家中保守处理的儿童。对于有警示体征的儿童，可能需要排除的发热严重病因包括感染（包括疟疾）、非感染性炎症性疾病和恶性肿瘤。单纯性热性惊厥本身并无危害，也不一定表明存在严重感染。在没有需要特定治疗的疾病时，缓解痛苦是开具药物治疗的主要指征，不应仅为降低体温而使用退烧药。必须注意避免用药过量，应向家长/照料者清楚说明在家中照顾孩子的方法以及何时寻求进一步医疗护理。
