Self-management of fever in patients with asplenia or hyposplenism

Give patients with asplenia or hyposplenism clear instructions about what to do if they develop symptoms or signs of infection. Instruct patients to seek urgent medical attention if they develop an unexplained fever. Ensure patients have an emergency supply of antibiotics, in case medical review is not immediately available.

Note: Instruct patients with asplenia or hyposplenism to seek urgent medical attention if they develop an unexplained fever.

For patients in whom medical care may be delayed (eg patients living in remote areas), an emergency management plan should be developed. Ongoing antibiotics are not a substitute for medical care; they should only be used when a patient cannot access medical care immediately.

Note: Ongoing antibiotics are not a substitute for medical care.

If sepsis or septic shock is confirmed on medical review, see Resuscitation of patients with sepsis or septic shock and Choice of empirical antibiotic regimen for sepsis or septic shock.

A suggested emergency regimen for adults with asplenia or hyposplenism who develop fever and are awaiting medical review isRubin 2014:

amoxicillin 2 g orally as a single dose, then seek medical care. If a delay to medical care is unavoidable, use 1 g orally, 8-hourly until medical review. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. amoxicillin amoxicillin amoxicillin

A suggested emergency regimen for children with asplenia or hyposplenism who develop fever and are awaiting medical review isKanhutu 2017:

amoxicillin+clavulanate (child 2 months or older) 22.5+3.2 mg/kg up to 875+125 mg orally as a single dose, then seek medical care. If a delay to medical care is unavoidable, continue 12-hourly until medical review¹. amoxicillin + clavulanate

For adults and children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, a suggested emergency regimen is:

cefuroxime 500 mg (child 3 months or older: 15 mg/kg up to 500 mg) orally as a single dose, then seek medical care. If a delay to medical care is unavoidable, continue 12-hourly until medical review². For dosage adjustment in adults with kidney impairment, see cefuroxime dosage adjustment. cefuroxime cefuroxime cefuroxime

For adults and children who have had a severe (immediate or delayed)³ hypersensitivity reaction to a penicillin, seek expert advice to guide antibiotic choice. A suggested emergency regimen is:

azithromycin 1 g (child: 20 mg/kg up to 1 g) orally as a single dose, then seek medical care. If a delay to medical care is unavoidable, continue daily until medical review⁴. azithromycin azithromycin azithromycin

For children in whom a suitable formulation of cefuroxime is not available, azithromycin may be an appropriate alternative.

¹ Amoxicillin+clavulanate may be suitable for children aged 1 month to younger than 2 months but a different dosage is required.Return

² Cefuroxime is preferred to cefalexin or cefaclor because of its superior antipneumococcal activity; see Practical information on using beta lactams: cephalosporins for further information.Return

³ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return

⁴ Azithromycin is not available on the pharmaceutical benefits scheme (PBS) for this indication. If the cost is prohibitive, an alternative macrolide (eg roxithromycin) may be considered.Return