What is the treatment for fever?

Treatment of Fever

Antipyretic medications should be used primarily for symptomatic relief and comfort rather than solely to reduce body temperature, as routine use of antipyretics does not improve clinical outcomes. 1

Pharmacological Management

First-line Treatments

• Acetaminophen (Paracetamol) is the preferred first-line antipyretic for most patients 1, 2

  • Standard adult dose: 1000 mg every 4-6 hours (not to exceed 4000 mg/day)
  • Preferred over NSAIDs, especially for viral infections 1
  • Mechanism: Central action on hypothalamic heat-regulating center

• NSAIDs (e.g., Ibuprofen) are effective alternatives 3

  • Standard adult dose: 400-600 mg every 6-8 hours
  • Use with caution in patients with:
    • Asthma (especially aspirin-sensitive)
    • Coagulation disorders
    • Renal impairment
    • Gastrointestinal conditions
    • Hepatic dysfunction

Combination Therapy

• Paracetamol/Ibuprofen combination (500mg/150mg) may be more effective than paracetamol alone for bacterial fever within the first hour of administration 4
• Consider this combination when rapid symptom relief is needed in bacterial infections

Non-Pharmacological Management

• Hydration: Advise patients to drink fluids regularly (no more than 2 liters per day) 1
• Avoid physical cooling methods like fanning, cold bathing, and tepid sponging as they cause discomfort 1
• Clothing/bedding: Light, minimal coverage to allow heat dissipation

Special Populations

Critically Ill Patients

• Treat fever promptly in critically ill patients, especially if infection is suspected 5
• Obtain cultures before initiating antimicrobial therapy
• Administer empirical antimicrobial therapy within 1 hour if sepsis is suspected 5
• Monitor temperature using central methods when accuracy is critical (pulmonary artery catheters, bladder catheters, esophageal thermistors) 1

Pediatric Patients

• Acetaminophen is the preferred antipyretic for children 1
• For infants 8-60 days old with fever:
  • Perform thorough evaluation for potential serious bacterial infections
  • Consider hospitalization and parenteral antimicrobial therapy based on risk stratification 5

Diagnostic Approach

Initial Evaluation

1. Temperature measurement: Use reliable methods (oral, rectal) when making critical clinical decisions 1
2. Identify underlying cause: Focus on treating the underlying condition rather than just the fever 1
3. Consider non-infectious causes of fever:
   • Drug fever
   • Thromboembolism
   • Malignancy
   • Autoimmune conditions
   • Post-surgical inflammation
   • Stroke 5

For Persistent Fever

• Chest radiograph for ICU patients with new fever 1
• Consider CT imaging for post-surgical patients with no obvious source 1
• For fever of unknown origin (FUO), consider advanced imaging such as PET/CT if initial tests are unrevealing 1

Common Pitfalls to Avoid

1. Overtreatment of fever: Treating fever solely to normalize temperature without addressing patient comfort or underlying cause
2. Relying on inaccurate temperature measurement methods (axillary, tympanic) when making critical clinical decisions 1
3. Delaying antimicrobial therapy when infection is strongly suspected in critically ill patients 5
4. Neglecting non-infectious causes of fever, which can lead to missed diagnoses
5. Excessive focus on antipyresis rather than treating the underlying condition

Remember that fever is often a beneficial host response to infection, and routine antipyretic use does not improve outcomes in most cases. Focus on patient comfort and treating the underlying cause rather than normalizing temperature.