Question: My 2 year and 10 month old son of average weight (30 lbs), good health, with no known allergies or health issues is on no medications. He lives in rural central Thailand and he continues to breast feed as he has since birth. He has healthy eating habits of fruits and vegetables as well. History: Approximately one month ago, he developed a cyst or blemish on the center edge of his left lower eyelid and another just inside his left nostril at the same time. Both blemish's grew in size to roughly 3mm in diameter. After roughly one week, we took him to the local hospital for a diagnosis and treatment. He was diagnosed with "eye disease", which was not very helpful. The doctor stated that it was not a syst. My son was prescribed an antibiotic that was administered as prescribed as well as an ointment that was also administered as prescribed. The Ointment was Fucidin-H Cream 5g (Fusidic Acid/Hydrocortisone). Unfortunately I don't recall the specific antibiotic. After several days, the blemishes on his eye lid and nostril seemed to have no impact from the prescription. The blemish on his eyelid ultimately grew slightly, developed a pus filled sac, burst on it's own, and diminished in size over the following week, but after the antibiotic prescription was depleted. The blemish on his eyelid remains but it is less than 2mm in diameter and no longer red in color or pus filled. the blemish in his nostril has largely if not completely disappeared. Approximately two weeks ago, my son developed an intermittent dry cough. This cough lasted for roughly a week with no other signs of sickness. His energy level remained the same, food and water intake remained unchanged, no high temperature, breathing normal. Four to five days ago, this cough began to sound more productive, wet. It seemed to be worse in the evenings and during the night. (He is typically outside in the hot humid air during the day and inside an air conditioned environment at night). The cough seemed to be getting worse as in deeper and more productive but remained very intermittent. It is aggravated with activity but also wakes him up in the night. Two to three days ago, he began to discharge large amounts of light yellow pus from his eye lids, presumably his tear ducts. He began to show signs of having difficulty breathing at night. He also began episodes of mild high fever 37*C to 38*C. These episodes seemed to come on quickly and diminish quickly as well. No Ibuprofen or acetaminophen was administered. Otherwise, his energy level, respiratory rate, food and water remained normal. Last night, while sleeping, his breathing was short and rapid. He seemed to be having trouble breathing with excessive flem and the threat of a cough. This morning, he displayed a marked lack of energy, a horse voice, no appetite for food, water or mothers breast milk. An extremely grumpy attitude, "No" to everything. He has also started reporting or commenting on seeing things like people, the sun, a light that are not in the room, as if he were hallucinating. We decided it was time for a doctors assistance. Taking him to the on duty pediatrician at the local hospital, his temperature had risen to 39*C on admission. The nursing staff tried to administer Ibuprofen but he would not take it. They used damp towels and a cool strip to successfully get his temperature down. The pediatrician ordered a nasal culture for a lab test. The results came back 40 minutes later: Influenza A, Negative, Influenza B, Negative; Influenza H1N1, Negative. Sensitivity 76.8% and Specificity 100%. Curiously, the lab report has some small print in Thai that has been translated as "H1N1 positive but insufficient to be relevant". The pediatrician diagnosed my son with "Acute Bronchitis" which I suspect translates as Respiratory Syncytial Virus (RSV). She prescribed the following medications: Nurofen Susp (Ibuprofen) 100 mg/5 ml, Tylenol Susp (Paracetamol) 160 mg/5 ml, Zyrtec Syr (CetRizine) 5mg/5 ml, Flemex + Ventolin Syr 60 ml, and Cefspan Susp (Cefixime) 100 mg/ 5 ml. After which my son was discharged. I am 54 years old, not on any drugs, and remain very weary of most all drugs. I understand Ibuprofen and Paracetamol are generally safe for a child of nearly three. I understand they are effective at relieving a high temperature. I also understand it is very dangerous to administer both in a short time span. Please correct me if I am wrong; The CetRizine does nothing to cure the patient but instead dampens the symptoms with potential health risks to the patient. The pharmacists concoction of some unknown ratio of Flemex and Ventolin may or may not be the pediatric versions but either way are similar to the CetRizine in that they only mask the symptoms with no proven health benefit and another potentially associated health risk of side effects. The Cefixime antibiotic is of no use against an almost certain virus. My intent at this point, short of additional information, is to not administer any of the prescriptions unless he develops another fever. In which case, I will administer Ibuprofen as prescribed. I will continue to monitor him while remaining alert to his respiratory rate, temperature, and signs of bluing in his extremities. I will try to push fluids and minimize activity, prop his head up while sleeping, and clean the mucous from his eyes. I also understand a saline nasal spray may be beneficial to loosen congestion. My questions is; is this approach prudent or should I follow the pediatricians order to pump him full of drugs as prescribed?

Dr XXXXXXX Amperayani,
Thank you for your concern.

1. What's the maximum recorded temperature?
The highest temp recorded was 39.6*C for less than an hour.
2. How's your son's activity when the fever touches base line?
I am not sure what you mean by "Base Line". As his temperature increases, he becomes increasingly lethargic to the point that he will just stare out the window.
3. Was any pus culture or blood culture sent?
No blood or pus cultures, only a swab of his nostril.
4. Total how many days of fever is it now?
His fever comes and goes but we are now into the second and possibly third day with fever temperatures
5. How's his oral intake?
His diminished oral intake began this morning and persisted throughout the day. It is now 0100 in the morning and he is drinking some water, he ate about half an apple, and he is nursing very lightly.
6. Is there any family or personal history of wheezing or Asthma?
No history of wheezing or Asthma.