What are the recommended medications and treatments for fever in India?

Recommended Fever Management in India

For fever management in India, paracetamol (acetaminophen) is the first-line antipyretic medication, recommended at a dose of 10-15 mg/kg every 4-6 hours (maximum 4 doses in 24 hours) for children and 500-1000 mg every 4-6 hours (maximum 4 doses in 24 hours) for adults. 1

First-Line Fever Management

Paracetamol (Acetaminophen)

• Adult dosing: 500-1000 mg every 4-6 hours, not exceeding 4 doses (4000 mg) in 24 hours
• Pediatric dosing: 10-15 mg/kg every 4-6 hours, not exceeding 4 doses in 24 hours
• Available as tablets, syrups, and drops for different age groups
• Popular Indian brands: Calpol, Dolo, Paracip, Febrinil

Non-Pharmacological Measures

• Tepid water sponging for high fevers, especially in children 1
• Adequate hydration with increased fluid intake
• Light, comfortable clothing
• Rest and proper ventilation

Second-Line Options

Ibuprofen

• Adult dosing: 400-600 mg every 6-8 hours, not exceeding 3 doses in 24 hours
• Pediatric dosing: 10 mg/kg every 6-8 hours, not exceeding 3 doses in 24 hours
• Popular Indian brands: Brufen, Ibugesic, Combiflam (combined with paracetamol)

Combination Therapy

• Fixed-dose combinations of paracetamol 500 mg, phenylephrine 10 mg, and chlorpheniramine maleate 2 mg are effective for fever associated with common cold 2
• Popular Indian brands: Crocin Cold & Flu, Coldrex, Vicks Action 500

Special Considerations for Specific Causes of Fever

Malaria Management

For malaria-induced fever in areas without chloroquine resistance 1:

• Adults: Chloroquine 600 mg, followed by 600 mg at 24 hours and 300 mg at 48 hours
• Children: Chloroquine 10 mg/kg, followed by 10 mg/kg at 24 hours and 5 mg/kg at 48 hours
• Pregnant women: Same as adult dosing (chloroquine is safe during pregnancy)

In areas with chloroquine resistance, alternative medications include:

• Sulfadoxine-pyrimethamine (SP) tablets (500 mg-25 mg)
• Mefloquine (250 mg weekly dose)
• Quinine for severe cases

Severe Malaria Management

For severe malaria with high fever 1:

1. Begin treatment immediately
2. If patient can swallow: Administer sulfadoxine-pyrimethamine tablets according to age
3. If patient cannot swallow: Quinine dihydrochloride 10 mg/kg IM
4. Reduce fever with paracetamol and tepid water sponging
5. Ensure adequate hydration with ORS

COVID-19 Associated Fever

For COVID-19 related fever 1:

• Paracetamol is preferred (ibuprofen 0.2 g per time, every 4-6 hours when temperature exceeds 38.5°C)
• Maintain temperature above 38°C for antiviral benefits
• Avoid blind use of antibacterial drugs unless secondary bacterial infection is suspected

Common Pitfalls in Fever Management

1. Overtreatment of mild fevers: Fever is a natural immune response and mild fevers (below 38.5°C) may not require antipyretic treatment 3

2. Exceeding recommended doses: Studies show 8-11% of patients exceed maximum recommended doses of antipyretics 4

3. Alternating antipyretics without proper timing: When using both paracetamol and ibuprofen, careful recording of dose times is essential to avoid accidental overdosing 4

4. Neglecting underlying cause: Fever is a symptom, not a disease; identifying and treating the underlying cause is crucial

5. Inadequate hydration: Febrile illness often causes mild dehydration requiring increased fluid intake

Special Populations

Children

• Paracetamol is preferred over aspirin to avoid Reye's syndrome
• Ibuprofen may provide longer fever relief (6-8 hours vs 4-6 hours for paracetamol) 4
• Combined therapy (paracetamol plus ibuprofen) provides additional 2.5 hours without fever compared to ibuprofen alone over 24 hours 4

Pregnant Women

• Paracetamol is the safest antipyretic during pregnancy
• For malaria, chloroquine is safe during pregnancy 1

Critical Care Patients

• Fever may increase oxygen consumption in unstable patients
• However, fever activates physiologic systems involved in pathogen clearance 5
• Balance between benefits and harms must be considered for each patient

Remember that fever is typically a short-lived symptom, with approximately 25% of children returning to normal by 48 hours and one-third by day 5 4. Always consider the underlying cause of fever and seek medical attention if fever persists beyond 3 days or is accompanied by concerning symptoms.