Dawaa Reference

infectious

Roseola Infantum (Exanthema Subitum)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

MSF Essential Drugs 2024 - paracetamol (oral) · NICE Clinical Knowledge Summaries: Roseola Infantum · WHO/UNICEF Joint Statement 2004 / WHO Diarrhoea Manual 2005 · WHO/UNICEF reduced-osmolarity oral rehydration salts (245 mOsm/L), recommended since 2002

Verified against3 documents
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • WHO/UNICEF Joint Statement 2004 / WHO Diarrhoea Manual 2005
  • Roseola Infantum - disease-level clinical article (roseola-infantum-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Fever is high, yet the child often still looks well and playful [fever]
  • Irritability, poor appetite, and cough or other upper respiratory symptoms may be reported [cough · irritability · poor appetite]
  • GI upset including loose stools can occur too [diarrhoea]
  • Caregivers may describe conjunctivitis or transient swelling around the eyes during the fever [fever]
  • Poor appetite, reduced feeding, and sleepiness are additional reported symptoms [drowsiness · poor appetite]

Signs — what you find (6)

  • Eyelid swelling, swollen lymph nodes, inflamed eardrums, and a bulging fontanelle can be found on exam [bulging fontanelle · eyelid swelling · lymphadenopathy]
  • Reddish papules on the soft palate and uvula appear in about two-thirds of cases (Nagayama spots) [papules]
  • The rash is rose-pink macules and maculopapules 2 to 5 mm across, sometimes with a pale halo [pallor · rash]
  • It appears first on the torso, then extends to the neck and proximal limbs, sparing the face
  • It blanches, does not itch, and clears within one to two days without peeling
  • Only a minority, about a quarter to a third, of infected children actually get the classic rash [rash]

Tests (6)

  • Routine tests are not needed for a child with a classic presentation
  • Blood counts may show an initial drop in white cells, normalizing within 7 to 10 days
  • About 13 percent of affected children have sterile pyuria, which can be mistaken for a urinary infection
  • A fourfold rise in HHV-6 IgG or seroconversion confirms infection in roughly three quarters of clinically diagnosed cases
  • Blood PCR for HHV-6 detects active infection, and viral culture yields best within the first three days of fever
  • Febrile infants 8 to 60 days old without the rash yet get worked up under standard fever protocols to exclude serious bacterial infection

If not this — what else fits (8)

  • Measles brings cough, coryza, and conjunctivitis before a head-to-toe rash with Koplik spots
  • Rubella causes a milder, short-lived rash with widespread lymph node swelling and little fever
  • Coxsackievirus A6 can cause an atypical hand-foot-mouth pattern with widespread blistering lesions
  • Adenovirus can mimic bacterial sepsis with fever, chest or gut symptoms, and conjunctivitis, peaking late winter to early summer
  • Parvovirus B19 gives a two-phase illness with a slapped-cheek or gloves-and-socks pattern
  • A finely papular red rash with streptococcal sore throat points to scarlet fever
  • Petechiae, purpura, and circulatory instability point to meningococcemia and need urgent workup
  • Fever lasting at least 5 days with mucocutaneous and extremity changes, plus raised inflammatory markers, suggests Kawasaki disease

SourceStatPearls "Roseola Infantum" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength120 mg

Formoral.liquid

Adult dose and duration

500-1000 mg three or four times a day as needed x 3-4 days during febrile phase

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(Give 15 mg/kg every 4-6 hours as needed; max 60 mg/kg daily Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

Paracetamol is an antipyretic and analgesic used to control the high fever of roseola infantum and reduce the risk of febrile seizures; it does not treat the underlying viral infection, which is self-limiting.

Cautions
  • The classic presentation is high fever for 3-5 days dropping abruptly, followed by a non-pruritic maculopapular rash on the trunk.
  • High fever causes febrile seizures in 10-15% of cases; advise parents on fever management and seizure first aid.
  • Reassure parents that condition is self-limiting and benign once rash appears.
  • 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case.
Egyptian brands
Egyptian brandManufacturerIndicative price
CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 MLMEMPHIS8.50 EGP
PARAGESIC BABY 120MG/5ML 120ML SUSP.AMRIYA36.00 EGP
PARAMOL 120MG/5ML SYRUP 125MLMISR36.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral liquidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral liquidPHAROPHARMA5.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Roseola Infantum - disease-level clinical article (roseola-infantum-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Any of these needs medical assessment: a seizure with the fever; fever persisting beyond 4 days; fever that settles and then comes back; a child feeding badly or drying out; drowsiness or irritability beyond what the illness explains; or anything pointing towards meningitis.
  • RED FLAG - Febrile infants aged 8-60 days without the characteristic rash should follow age-specific fever protocols to rule out serious bacterial infection before a roseola diagnosis is assumed.
3

ORS

add-on - not a substitute

Formoral.liquid

Adult dose and duration

Sip fluid/ORS solution as needed x 3-4 days

Paediatric dose

Offer small frequent fluid sips to prevent dehydration during high fever

Dose source

WHO/UNICEF Joint Statement 2004 / WHO Diarrhoea Manual 2005

Why

Oral rehydration salts are given alongside antipyretic care to maintain fluid and electrolyte balance during the febrile illness of roseola; they do not treat the underlying viral cause.

Cautions
  • Ensure adequate oral fluid intake.
  • Watch for signs of dehydration or lethargy.
  • Use the reduced-osmolarity formulation (sodium 75, glucose 75, potassium 20, citrate 10, chloride 65 mmol/L; 245 mOsm/L). WHO replaced the older 311 mOsm/L formula in 2002 for diarrhoea of any cause at any age - it cuts stool output and vomiting.
Egyptian brands
Egyptian brandManufacturerIndicative price
GLUCOHYDRAN 10 SACHET.ARAB DRUG COMPANY (ADCO)1.75 EGP
REHYDRAN N 10 SACHETCID4.50 EGP
REHYDRO ZINC 10 SACHETSCID7.00 EGP
ORS 20 SACHETSPHAROPHARMA40.00 EGP
ELECTRO MASH SYRUP 200 MLMASH PREMIERE60.00 EGP
FLEXOLYTE ORAL REHYDRATION SOL. 240 MLKEMPETRO FOR CHEMICAL INDUSTRIES65.00 EGP
HERO ORS 200 MLHERO > HERO MEA TRADING120.00 EGP
SANSO ORS SYRUP 140 MLAUG PHARMA400.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.