Neeraj Kumar Tulara has completed his Post graduate Diploma in Infectious Disease from South Wales University, Australia. He is a Diplomate at National Board-Internal Medicine, India. He is an MBBS (Bachelor of Medicine and Surgery), India. He is a Member of IDSA, USA. He is an Editor for SM Tropical Medicine Journal, USA and a Reviewer of Biomedical Sciences, USA.


Background: Fever is most common presentation of any disease of any etiology. For children many fever protocol has been practiced in developed and also developing world but for fever in adult patients there are paucity of literature about how to investigate and treat the adult patient presenting first time with the fever in emergency care.

Objective: Objective of this study is to devise standard care pathway for all adults who presents with fever with no localizing signs in order to avoid unnecessary investigation and unwanted antibiotics. After devising fever protocol, pilot study was performed to see its effectiveness.

Methods: A protocol was formulated for all adults presenting with fever without any signs of SIRS and no localizing signs to suggest the clear etiology of the fever. Initial investigations were based on duration of fever, type of fever and associated symptoms along with fever. Treatment was based on the results of investigations. A pilot study was conducted wherein all adults with fever were included and data were analyzed.

Results: During the 3 month study period 1109 adult patients were presented with fever in emergency department, out of them 876 were fitting in the parameters of devised protocol with 659 patients were presented within the first 48 hours of the onset of fever. All patients experienced the defervescence of the fever. Of the patients presented within 48 hours, 69.8% (460/659) defervesced without the need of any investigations and 63.2% (416/659) defervesced without the need of any antibiotic therapy.

Conclusion: Implementation of fever protocol in emergency care department helped to reduce the unnecessary investigation and antibiotics. Thus reducing the cost of the management of fever and also the most important is to help in reducing the antimicrobial resistance by reducing the unwanted used of antimicrobials.