# Rubella (German Measles) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: MSF Essential Drugs 2024 - paracetamol (oral) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - Rubella - disease-level clinical article (rubella-clinical.txt) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text RUBELLA (GERMAN MEASLES) Sources: MSF Essential Drugs 2024 - paracetamol (oral) Review status: REVIEWED against MSF Essential Drugs 2024 - paracetamol (oral), Rubella - disease- level clinical article (rubella-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - About a quarter to half of postnatal cases have no symptoms at all - After an incubation of 14 to 21 days, a mild prodrome brings low fever, tiredness, poor appetite, headache, and sore throat [fatigue · fever · headache · poor appetite · sore throat] SIGNS - what you find (9) - Swollen glands are typically felt behind the ears, at the base of the skull, and in the front of the neck [lymphadenopathy] - A rash of pinpoint pink spots and bumps starts on the face and quickly spreads to the body and limbs [rash] - The eruption can look scarlatiniform or purpuric, lasts about 3 days, and clears in the order it appeared [purpura · rash] - Petechiae on the soft palate, called Forchheimer spots, are seen in roughly one in five cases [petechiae] - Maternal infection in the first trimester of pregnancy classically gives the newborn cataracts, a heart defect, and sensorineural hearing loss [hearing loss] - Affected newborns can show low birth weight, low platelets with bruising, haemolytic anaemia, and an enlarged liver and spleen [anaemia · bruising · hepatomegaly] - Hearing loss is the single most common finding of congenital rubella and can be the only abnormality present [hearing loss] - A purplish spotted blueberry-muffin rash reflects extra blood-cell production in the skin [rash] - Long-bone x-rays can show a radiolucent, striped celery-stalk pattern at the metaphyses TESTS (8) - IgM antibody to rubella by EIA is the usual test for recent postnatal infection and becomes positive about 4 days after the rash starts - A fourfold or greater rise in IgG between acute and convalescent samples also confirms infection - Low-avidity IgG helps confirm a recently acquired primary infection - A pregnant woman exposed to rubella should have immediate IgG testing; a negative result needs repeat IgG/IgM after 3 weeks - Fetal infection can be shown by IgM in fetal blood, or by rubella RNA on RT-PCR from amniotic fluid, fetal blood, or a chorionic villus sample - In a newborn, IgM within the first 6 months, or rising IgG after 6 to 12 months, confirms congenital infection - PCR on nasopharyngeal swabs, urine, or saliva detects rubella RNA and supports a CRS diagnosis - Postnatal ELISA for IgG in neonatal serum runs near 100 percent sensitivity and specificity under 3 months of age IF NOT THIS - what else fits (4) - Measles, HHV-6/7, infectious mononucleosis, and cytomegalovirus can produce a similar-looking rash - Zika, West Nile, Ross River fever, and Chikungunya are arboviral mimics of the rash - Parvovirus B19, mycoplasma, scarlet fever, and enteroviruses are other infectious look-alikes - Drug eruptions, contact dermatitis, and Kawasaki disease are the noninfectious mimics named Source StatPearls "Rubella" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g three or four times daily, maximum 4 g in 24 hours - As needed for pain or fever Peds 15 mg/kg/dose [child max 500 mg] (Child 1 month and over: 15 mg/kg per dose, 3 or 4 times daily, maximum 60 mg/kg daily. Child under 1 month: 10 mg/kg per dose, 3 or 4 times daily, maximum 40 mg/kg daily. MSF's own weight table gives one 500 mg tablet three times daily from 30 kg to under 50 kg, so 500 mg is the per-dose ceiling; the 60 mg/kg daily total still applies.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Symptomatic relief of the pain and fever only. It does not treat the cause, and the dose is the same whatever the cause is. Caution Pregnant contact with unknown or no immunity - needs urgent serology and counselling. Relief only - it does not treat what is causing the pain or fever. Check every other product the patient is taking for paracetamol; combination cold and flu preparations are the usual route to an accidental overdose. Reduce the dose in significant liver disease, chronic alcohol use, or low body weight. RED FLAG - Arthritis or encephalitis, or petechiae or bleeding from thrombocytopenia - all rare complications. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Rubella - disease-level clinical article (rubella-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Pregnant women exposed to suspected rubella require immediate serologic IgG testing; infection before 18 weeks gestation carries high risk of fetal infection/congenital malformation and may warrant discussion of pregnancy termination. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)