Management of adolescents and adults with febrile illness in resource limited areas

Overlap in the clinical features of febrile illnesses and limited laboratory services make the management of febrile patients in resource limited settings challenging. WHO guidelines for managing febrile adolescents and adults in resource limited settings are available for first level health facilities and are forthcoming for district hospitals. First level health facility guidelines recommend antimalarials for those with a positive malaria diagnostic test, antibacterials for those with signs of severe illness or specific bacterial infections, and hospital referral of those with severe illness or no apparent diagnosis. Management guidelines should be validated, locally adapted, and improved on the basis of local or national surveillance data and sentinel hospital studies. Malaria, tuberculosis, and HIV diagnostic tests can enhance management by ruling out a specific illness or by directing towards a particular diagnosis. Clinical trials of empirical treatment strategies and advocacy for better clinical laboratory services could help improve management guidelines and patient outcomes.