# Roseola Infantum (Exanthema Subitum) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Paracetamol — 120 mg — oral.liquid - Referral & safety-netting (no drug therapy) - ORS — oral.liquid ## Complete treatment card ```text ROSEOLA INFANTUM (EXANTHEMA SUBITUM) 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 Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Roseola Infantum" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 500-1000 mg three or four times a day as needed x 3-4 days during febrile phase Peds 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).) 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 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. Caution 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. Egypt CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 ML MEMPHIS 8.50 EGP PARAGESIC BABY 120MG/5ML 120ML SUSP. AMRIYA 36.00 EGP PARAMOL 120MG/5ML SYRUP 125ML MISR 36.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral liquid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral liquid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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] Adult Sip fluid/ORS solution as needed x 3-4 days Peds Offer small frequent fluid sips to prevent dehydration during high fever 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. Caution 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. Egypt GLUCOHYDRAN 10 SACHET. ARAB DRUG COM... 1.75 EGP REHYDRAN N 10 SACHET CID 4.50 EGP REHYDRO ZINC 10 SACHETS CID 7.00 EGP ORS 20 SACHETS PHAROPHARMA 40.00 EGP ELECTRO MASH SYRUP 200 ML MASH PREMIERE 60.00 EGP FLEXOLYTE ORAL REHYDRATION SOL. 240 ML KEMPETRO FOR CHEMICAL INDUSTRIES 65.00 EGP HERO ORS 200 ML HERO > HERO M... 120.00 EGP SANSO ORS SYRUP 140 ML AUG PHARMA 400.00 EGP 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)