a. It is important to decide which child needs an antibiotic. In general, antibiotic should not be used in absence of fever but at the same time mere presence of fever does not justify antibiotic.
b. Acute onset of fever may be taken as acute infection and one must differentiate between viral and bacterial infection. Detailed history including onset, response to paracetamol, behaviour during inter-febrile period, rhythm and progress by day 3-4 help in determining type of infection.
c. Antibiotic response is evident only after 2-3 days and if there is no response at the end of 4 days, one must evaluate again and not just change antibiotic irrationally.
d. Wrong diagnosis, improper choice of antibiotic, non-infective complications or immune-deficient host are reasons for failure of antibiotic and drug resistance should be the last probability only after other causes are ruled out.
Dr Yeshwant Amdekar is one of the senior most practicing pediatricians in India having been in paediatric practice for last 47 years. He served as a teacher at Grant Medical College for 30 years and retired as a professor of Pediatrics in the year 2000. He has taught an entire generation of paediatricians and continues to do so even today.
He is presently Medical Director of the B.J.Wadia Hospital for children which is Mumbai's only dedicated and largest children's hospital. He was President of the Indian Academy of Pediatrics in the year 1995 and has served the academy in various positions. He has also authored four books and has contributed articles in indexed journals and chapters in textbooks. He has been a recipient of many prestigious orations.
Dr Amdekar has been a great source of encouragement to young paediatricians as well as development of paediatric sub-specialities including paediatric hepatology.