What are the Philippine Pediatric Society's guidelines for managing children with non‑specific viral illness and fever?

Philippine Pediatric Society Guidelines for Non-Specific Viral Illness and Fever

I was unable to locate specific published guidelines from the Philippine Pediatric Society (PPS) addressing non-specific viral illness and fever in the provided evidence. The available evidence consists primarily of British, American, and other international guidelines, along with limited Philippine research data on specific infections rather than general viral illness management protocols from the PPS.

What the Available Evidence Shows About Pediatric Fever Management

Initial Home Management for Mild Illness

Most children with mild fever and cough should be managed at home with antipyretics and fluids, avoiding aspirin in children under 16 years due to Reye's syndrome risk. 1

• Fever alone with mild upper respiratory symptoms represents the majority of pediatric presentations and is typically viral in etiology 2, 3
• Supportive care with adequate hydration and comfort measures is the primary intervention 1
• Parents should monitor for red flag symptoms requiring medical evaluation 3

When to Seek Medical Evaluation

Children require assessment by a healthcare professional when they have: 1

• High fever >38.5°C with cough or influenza-like symptoms
• Age under 1 year with any significant fever
• Breathing difficulties (increased respiratory rate, grunting, intercostal retractions)
• Severe earache
• Vomiting >24 hours
• Drowsiness or altered consciousness
• Signs of dehydration (decreased urine output, dry mucous membranes, lethargy)
• Rash with fever (especially non-blanching)

Risk Stratification for Serious Bacterial Infection

Age-specific risk assessment is critical, with neonates and young infants requiring different management than older children: 4

• Neonates (<28 days): Highest risk group requiring hospital admission and full sepsis workup 4
• Young infants (1-3 months): May be risk-stratified using clinical and laboratory criteria; low-risk infants may be managed as outpatients with close follow-up 4
• Children >3 months: Clinical appearance and specific symptoms guide management decisions 3, 4

Laboratory and Diagnostic Testing

Investigations should be targeted based on clinical presentation and risk factors, not routinely performed for all febrile children: 1, 5

• Full blood count, electrolytes, and blood cultures are indicated for severely ill children requiring hospitalization 1
• Chest radiography should only be performed if respiratory symptoms are present (hypoxia, severe respiratory distress, or clinical deterioration) 1
• Urinary tract infection accounts for >90% of serious bacterial illness in young children and should be considered, especially in those <2 years 4

Antibiotic Indications

Antibiotics are NOT routinely required for non-specific viral illness but should be given to high-risk children: 1

Children requiring antibiotics include those with: 1

• Chronic comorbid conditions (congenital heart disease, chronic lung disease, immunodeficiency)
• Clinical features suggesting bacterial infection (focal findings, severe illness, persistent high fever)
• Age <1 year with high fever and risk factors
• Pneumonia or other confirmed bacterial infection

For children under 12 years requiring antibiotics, co-amoxiclav is the first-line choice (covers S. pneumoniae, S. aureus, and H. influenzae) 1

• Clarithromycin or cefuroxime for penicillin-allergic children 1
• Oral route is preferred if the child tolerates oral fluids 1

Hospital Admission Criteria

Children require hospitalization when they have: 1

• Oxygen saturation ≤92% in room air
• Severe respiratory distress with raised PaCO2
• Signs of shock (hypotension, poor perfusion, altered consciousness)
• Inability to maintain oral intake requiring IV fluids
• Age <1 year with concerning features
• Recurrent apnea or irregular breathing

Supportive Care in Hospital

Oxygen should be administered to maintain saturation >92% via nasal cannulae, head box, or face mask 1

• IV fluids should be given at 80% maintenance in severe pneumonia to avoid fluid overload 1
• Enteral route is preferred when possible for fluid administration 1

Discharge Criteria

Children can be safely discharged when: 1

• Clearly improving clinically
• Physiologically stable
• Tolerating oral feeds
• Respiratory rate <40/min (<50/min in infants)
• Oxygen saturation >92% in room air

Philippine Context Considerations

Limited Philippine data shows that bacterial pathogens in young Filipino infants differ from Western patterns: 6

• Salmonella species were the most common bacterial pathogen, followed by gram-negative organisms 6
• Pneumococcus was an unusual cause in this population 6
• Enteroviruses were the most common viral pathogen (22%), followed by RSV (17%) 6

Recent Philippine COVID-19 data demonstrates that most pediatric admissions were mild cases with underlying comorbidities: 7

• Elevated inflammatory markers (D-dimer, LDH, IL-6, ferritin, procalcitonin) were associated with severe disease 7
• Antibiotics were given to 71.7% of admitted children, though most had viral illness 7

Critical Pitfalls to Avoid

Do not rely solely on clinical appearance to exclude serious bacterial infection, as many children with bacteremia appear well initially 5

• Recent antipyretic use may mask fever severity and should be considered in assessment 5
• Avoid routine antibiotic prescription for viral illness, as this contributes to antimicrobial resistance 1, 3
• Do not use aspirin in children under 16 years due to Reye's syndrome risk 1
• Avoid routine chest radiography in children without respiratory symptoms 1