What is the treatment for fever?

Treatment of Fever

Fever should be treated with acetaminophen (paracetamol) as first-line therapy for symptomatic relief when patients are uncomfortable, with ibuprofen as an alternative option. 1, 2

Initial Assessment

Before treating fever, it's important to identify the underlying cause:

• Perform a thorough physical examination focusing on common infection sites (periodontium, pharynx, lungs, perineum, skin) 1
• Obtain travel history to identify potential geographic-specific infections 1
• Consider both infectious and non-infectious causes (drug reactions, thromboembolism, malignancy, autoimmune conditions)

Treatment Algorithm

First-Line Treatment

• Acetaminophen (Paracetamol) 1, 2
  • Adult dosing: 1000 mg every 4-6 hours (not exceeding 4000 mg in 24 hours)
  • Preferred for most patients, especially those with viral infections
  • Lower risk of side effects compared to NSAIDs

Alternative Treatment

• Ibuprofen 1, 3
  • Adult dosing: 200-400 mg every 4-6 hours (not exceeding 1200 mg in 24 hours)
  • May be more effective for bacterial fever in the first hour after administration 4
  • Use with caution in patients with:
    • Asthma (especially aspirin-sensitive)
    • Gastrointestinal disorders
    • Renal impairment
    • Cardiovascular disease

When to Treat

• Treat fever above 38.5°C (101.3°F) if the patient is uncomfortable 1
• Temperatures below 38°C generally don't require antipyretic treatment unless the patient is symptomatic 1
• Focus on treating the underlying cause rather than just suppressing temperature 1, 5

Special Considerations

Children

• Paracetamol is the preferred antipyretic 1
• Physical methods such as cold bathing and tepid sponging are not recommended as they can cause discomfort 6
• Ensure adequate fluid intake to prevent dehydration 6

Critically Ill Patients

• The American College of Critical Care Medicine recommends prompt treatment of fever in critically ill patients 1
• Focus on identifying and treating the underlying cause 1
• Administer empirical antimicrobial therapy within 1 hour if sepsis is suspected 1

Intracerebral Hemorrhage

• Pharmacologically treating elevated temperature may be reasonable to improve functional outcomes in patients with spontaneous intracerebral hemorrhage 6
• The usefulness of therapeutic hypothermia (<35°C/95°F) to decrease peri-ICH edema is unclear 6

Common Pitfalls to Avoid

1. Overtreatment of fever without addressing the underlying cause 1
2. Relying on inaccurate temperature measurement methods 1
3. Delaying antimicrobial therapy when indicated 1
4. Neglecting non-infectious causes of fever 1
5. Excessive focus on antipyresis rather than treating the underlying condition 1, 5

Evidence on Antipyretic Use

There is ongoing debate about whether routine antipyretic therapy is beneficial:

• Some evidence suggests fever may benefit host defense mechanisms 5
• Routine antipyretic administration is not supported by current evidence 7
• Consider individual patient factors such as comorbidities and symptoms when deciding to treat fever 7

In most patients, fever is short-lived and causes only minor discomfort, so antipyretic therapy should be used judiciously, particularly in patients with underlying cardiovascular or neurologic disorders 5.