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What Does Persistent Low Grade Fever In A Child While On Antibiotics Indicate?

Posted on Sat, 11 Apr 2015

Question: my daughter has had a low grade fever (99.5-100) for 3 weeks - during this time she tested positive for strep was given amoxacelin for 10 days, at the end of that she tested positive again for strep and her temp remained at 99.5. They prescribed clarithromycin for 10 days and she has been on that for 5 days and her temp remains at 99.6-100 without any change. They did blood work a week ago to see if white blood cell count is high and it wasn't high. we are very concerned that there is something else going on with our 5 year old. what could be causing this??? she doesn't have a runny nose, no cough, no sore throat...seems really normal (not tired) but we know a fever for 3 weeks will on antibiotics is not normal...please help

Answered by Dr. Eric Goldstein (2 hours later)

Brief Answer:
Strep

Detailed Answer:
Hello. I just read through your question.
Failure of Amoxicillin to cure strep does happen from time to time. A 10 day course of a second antibiotic is the correct approach when something like that happens. The normal white count in the blood test is a very encouraging sign. The other, perhaps more important, encouraging sign is the fact that she looks and feels well.
When the temperature is under 101, and the child feels and looks fine, there is noyhing to worry about. The blood test confirms this. When a child's temperature is persistently 101 or higher, it might be a cause for concern. But not when it is below that.
In this case, we don't have to worry about the number on the thermometer. Hope the course of Clarithromycin will erdiacte the strep. If it does, we can leave her be.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Eric Goldstein (1 hour later)

thank you for the reply. We are concerned because she has been on the second round of antibiotics for 5 days now and her temperature has not gone down. I would think that after 48 hours the antibiotic would have kicked in, helped, and reduced her temperature. We will be brining her in to her family doctor on Monday due to this concerns...what should we be asking her?, what tests should be run, I just want to rule out everything including things like cancer or other serious health issues that we have read up on...having a fever for over 3 weeks even though it is low grade is not the norm for our little girl. When she has had strep in the past or other things she will run a temp of 102-103 for a few days, but it has never lasted more than 1 week. Your advice on what we should be asking or asking for in terms of tests will help put our mind at ease that we are not missing something.
thanks again

Answered by Dr. Eric Goldstein (45 minutes later)

Brief Answer:
Follow up

Detailed Answer:
I appreciate and respect your concern.
If I did do blood work I would run the following:
A complete blood count (CBC). This is the same test they ran earlier.
Additionally, I would order an ESR and CRP.
I would also consider discussing Mono with your doctor. A simple blood test can be done for this to.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar