Most of the common fevers seen in community practice may be due to :

1. Viral infection like flu
   
2. Sore Throat, which may be viral or bacterial
   
3. Malaria
   
4. Pneumonia or bronchitis
   
5. Typhoid
   
6. Viral hepatitis
   
7. Amoebic liver abscess
   
8. Lower urinary tract infection in females
   
9. Chest tuberculosis
   
10. Dengue (less common)
    
11. Leptospirosis (less common)

In the entire list, I cannot see any condition which calls for the use of common antibiotics, except perhaps pneumonia, leptospirosis or urinary tract infection.

All over the world, there is a difference of opinion on whether sore throat should be treated with antibiotics or not. Most of such patients have associated nasal cold and generalised malaise, which points towards a viral origin. But there are some authorities, who feel that antibiotics can be used in patients having sore throat. Of course, if the patient gets a typical attack of tonsillitis with fever, pain at the angle of the mandible, swollen red tonsils with exudates, enlarged lymph glands at the angle of the mandible and blood count showing leucocytosis, then in that case there is no difference of opinion on administering antibiotics.

Coming to the second condition of pneumonia and bronchitis-many cases of bronchitis occur due to viral infection or allergy or both, but unless the patient's sputum is yellow or the patient has underlying COPD, antibiotics are not indicated. Similarly, pneumonias which are viral and are associated with blood test showing leucopenia will not respond to common antibiotics. Acute bacterial pneumonia responds very well to the antibiotics.

Lower Urinary Tract Infection which is quite common in women, if properly diagnosed responds to antibiotics within three days. But very often, these infections are not associated with fever, which we are discussing here.

Leptospirosis responds to antibiotics, but before starting antibiotics, this illness must be confirmed by the presence of leucocytosis, abnormal urine picture, abnormal blood tests showing a combination of abnormalities of liver and kidney functions with a positive blood test of ELISA.

Typhoid is the only fever, where antibiotics have to be used, otherwise occasional deaths can take place. Only if the antibiotics are started on the 4th or 5th day in a proper dose and continued till the fever responds and 10 days thereafter, that the typhoid fever is cured and will not relapse. Therefore, in present days, when organisms are changing their response to antibiotics, it is better to get 2-3 blood cultures and isolate salmonella and see their antibiotic sensitivity report, especially to check if they are resistant to nalidixic acid.

Thus, my advice will be to start paracetamol four times a day in every patient having common fever, whether high or low and advise "tepid sponging" whenever the fever is very high. Observe the patient day to day and make proper diagnosis even if it takes 4-5 days. I am very happy that many authorities have labelled common fevers seen by general practitioners as "pyrexia of unknown origin".

Vice versa, compared to olden days, pyrexia of unknown origin today is much easier to diagnose with the help of blood culture, marrow examination, blood serological tests and modern imaging in addition to very good history taking and clinical examination.

Nowadays, it takes only 2-3 days to find out the cause of so-called PUO of olden days!