Management and Treatment for FUO depends on the diagnosis or the absence of a diagnosis.
Management and Treatment of FUO in Which a Diagnosis Is Made
An identified cause of the fever is treated according to the protocols for the particular illness responsible. Treatment for infections, inflammatory conditions, and malignancy are according to specified protocols. When a definitive diagnosis is absent and all screening, diagnostic, and imaging tests are negative, the final tactic is to treat the fever as its own disease.
Management and Treatment of FUO in which a Diagnosis Remains Unknown: Risk Stratification
How patients are approached therapeutically is delineated based on a risk stratification protocol determined by a multinational scoring system that uses weighted measures such as symptoms and white blood cell count (neutropenia), and the presence or absence of hypotension, dehydration, and age:
● For low risk patients: In the absence of any imminent danger, expectant therapy vs. empiric trials of antibiotics and other drugs is based on physician preference, patient dissatisfaction (loss of employment, etc.), and duration of illness.
● For high risk patients: Liberal consultation with infectious disease, rheumatic disease, and immunology specialists should occur before resorting to empiric therapy.
- Initial empirical antibiotic therapy: Should be followed by anti-fungal therapy if results are negative. After treatment/prophylaxis of infectious agents, empiric anti-inflammatories can be tried. Anti-pyretics (drugs to lower fever) should be used with caution as they can mask the actual presentation, misleading a physician into a misdiagnosis.
Many drugs have fever as a side effect. A drug fever becomes more likely the more drugs a person is taking, making the elderly and those with chronic disease most at risk. Failure to identify a drug fever leads to unnecessary hospitalization, testing, and therapies that pose risks in any risk-vs-benefit rationale.
A drug fever must initially be a diagnosis of exclusion. If a drug fever is suspected, therapy calls for cessation of the drug and possibly re-introducing it to confirm its effect. If so, alternative drugs are used.