What is the treatment for fever?

Treatment of Fever

For fever above 38.5°C, ibuprofen or acetaminophen (paracetamol) should be used for symptomatic relief, while temperatures below 38°C generally do not require antipyretic treatment unless the patient is uncomfortable. 1

Antipyretic Medications

First-line options:

• Acetaminophen (Paracetamol): Preferred for most patients 2, 3

  • Dosing: 500-1000 mg every 4-6 hours (adults), not exceeding 4000 mg in 24 hours
  • Advantages: Safer profile for patients with viral infections, gastrointestinal concerns, or bleeding risk

• Ibuprofen: Alternative option 1, 4

  • Dosing: 200-400 mg every 4-6 hours (adults), not exceeding 1200 mg in 24 hours
  • Caution: Avoid in patients with aspirin-sensitive asthma, coagulation disorders, or renal impairment

Addressing the Underlying Cause

Treating fever should focus primarily on identifying and addressing the underlying cause rather than just suppressing the temperature. Common causes include:

1. Infectious causes:

   • Obtain appropriate cultures before starting antimicrobials when infection is suspected 2
   • For suspected bacterial infections, empiric antibiotics should be initiated promptly
   • For specific infections like pneumonia, appropriate antibiotics should be selected based on likely pathogens

2. Non-infectious causes:

   • Drug fever: Discontinue suspected medication
   • Thromboembolism: Appropriate anticoagulation
   • Autoimmune conditions: Disease-specific treatment
   • Post-surgical inflammation: Supportive care

Special Considerations

• Neutropenic fever: Requires prompt empiric broad-spectrum antibiotics 1

  • High-risk patients: Use monotherapy with antipseudomonal β-lactam or carbapenem
  • Low-risk patients: Consider oral antibiotics or outpatient management if infrastructure supports careful monitoring

• Critically ill patients:

  • Obtain cultures before starting antimicrobials 1
  • Use accurate temperature measurement methods (oral, rectal, or central) 2
  • Consider broader antimicrobial coverage if clinically unstable 1

• Fever of Unknown Origin (FUO):

  • Avoid empiric antimicrobial therapy unless patient is neutropenic, immunocompromised, or critically ill 5
  • Consider advanced imaging like 18F-FDG PET/CT if initial tests are unrevealing 2, 5

Supportive Measures

• Ensure adequate hydration 2
• Avoid physical cooling methods like cold bathing or tepid sponging as they cause discomfort 2
• Monitor for response to antipyretic therapy

Common Pitfalls to Avoid

1. Overtreatment of low-grade fever (< 38°C) when patient is comfortable 2
2. Relying on inaccurate temperature measurement methods (axillary, tympanic) 2
3. Delaying antimicrobial therapy when infection is strongly suspected in critically ill patients 2
4. Neglecting non-infectious causes of fever 2, 5
5. Excessive focus on antipyresis rather than treating the underlying condition 2, 6

Remember that fever is an adaptive physiological response that may have beneficial effects in fighting infection. Treatment should focus on patient comfort and addressing the underlying cause rather than normalizing temperature for its own sake 6, 7.