From the Guidelines
To treat a fever, antipyretic therapy, comprising regular paracetamol and/or physical cooling measures, should be used routinely where fever occurs. This approach is supported by the most recent and highest quality study available, which suggests that antipyretic therapy can be beneficial in optimizing patient comfort and reducing metabolic demand in certain clinical scenarios 1.
When using antipyretic therapy, it is recommended to take over-the-counter medications like acetaminophen (Tylenol) at a dose of 325-650 mg every 4-6 hours (not exceeding 3,000 mg daily) or ibuprofen (Advil, Motrin) at 200-400 mg every 4-6 hours with food. Additionally, staying hydrated by drinking plenty of fluids, especially water, clear broths, or electrolyte solutions, is essential. Rest is also crucial to help the body fight the underlying cause of the fever.
Some key points to consider when treating a fever include:
- Applying a lukewarm compress to the forehead or taking a lukewarm bath to help lower the temperature
- Dressing in light, breathable clothing and keeping the room temperature comfortable
- Recognizing that fevers are the body's natural defense mechanism against infection, with the increased temperature helping to kill pathogens
- Seeking medical attention if the temperature exceeds 103°F (39.4°C), lasts more than three days, or is accompanied by severe headache, stiff neck, persistent vomiting, difficulty breathing, confusion, or rash.
It is also important to note that the use of antipyretics in febrile patients with sepsis-associated organ dysfunction is a topic of ongoing debate, and the optimal approach to fever in these patients is not yet clear 1. However, based on the available evidence, antipyretic therapy can be a reasonable approach to optimize patient comfort and reduce metabolic demand in certain clinical scenarios.
From the FDA Drug Label
Stop use and ask doctor if ... fever gets worse or lasts more than 3 days PURPOSE Pain reliever/fever reducer The treatment for fever is to use a pain reliever/fever reducer such as acetaminophen (PO) 2, 2.
- If the fever gets worse or lasts more than 3 days, stop use and ask a doctor. Key points to consider when treating fever:
- Duration: fever lasting more than 3 days may require medical attention
- Severity: worsening fever may be a sign of a serious condition It is essential to follow the recommended usage and consult a doctor if the fever persists or worsens 2.
From the Research
Treatment Options for Fever
- Paracetamol (acetaminophen) is a commonly used medication for treating fever in children, with a recommended dose of 10-15 mg/kg every 4 hours, up to a maximum of four doses per day 3.
- Ibuprofen is also effective in reducing fever, with a recommended dose of 10 mg/kg per dose, and may be more effective than paracetamol in some cases 4.
- The use of both paracetamol and ibuprofen together may be more effective than using either medication alone, but it is essential to carefully record dose times to avoid exceeding the maximum recommended dose 5.
Considerations for Treatment
- Fever itself is not the primary illness, but rather a physiologic mechanism that has beneficial effects in fighting infection, and the primary goal of treating a febrile child should be to improve their overall comfort rather than focusing on normalizing body temperature 6.
- There is no evidence that fever worsens the course of an illness or causes long-term neurologic complications, and antipyretic use should be focused on relieving discomfort rather than suppressing fever 7, 6.
- Pediatricians should promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices, and by counseling parents on the importance of monitoring activity, observing for signs of serious illness, and encouraging appropriate fluid intake 6.
Safety and Efficacy
- Paracetamol and ibuprofen are generally safe and effective in treating fever in children, with no substantial difference in safety and effectiveness between the two medications 3, 6.
- However, there are concerns about the potential for liver toxicity with paracetamol overdose, and the importance of careful dosing and monitoring to avoid exceeding the maximum recommended dose 3.
- Ibuprofen suspension may be a safe and effective antipyretic in children, with a dose-response relationship demonstrated in terms of percentage of fever reduction and initial 2-hour rate of decrease in temperature 4.