Is paracetamol recommended in viral fever?

Paracetamol in Viral Fever Management

Paracetamol (acetaminophen) is recommended for temperature control in viral fever as it effectively reduces fever and associated discomfort with a favorable safety profile. 1

Evidence for Paracetamol Use in Viral Fever

Paracetamol is well-established as a first-line antipyretic agent for viral fevers based on several guidelines:

• The Clinical Microbiology and Infection guideline for management of acute sore throat (which is often viral in origin) recommends paracetamol as an effective antipyretic and analgesic 1
• The American Academy of Otolaryngology-Head and Neck Surgery guideline specifically recommends acetaminophen (paracetamol) for pain or fever in viral rhinosinusitis 1
• For critically ill adults with COVID-19 who develop fever, the Surviving Sepsis Campaign guidelines suggest using acetaminophen/paracetamol for temperature control 1

Route of Administration

While the question specifically asks about intramuscular (IM) administration, most guidelines recommend oral paracetamol as the primary route. The evidence for IM paracetamol in viral fever is limited, and oral administration is generally preferred due to:

• Better safety profile
• Ease of administration
• Comparable efficacy to IM formulation for fever control
• Lower risk of injection site complications

Efficacy Considerations

Paracetamol has demonstrated effectiveness in fever reduction:

• Studies show paracetamol reduces body temperature by approximately 1-1.3°C within 4 hours of administration 2
• It provides symptomatic relief of fever-associated discomfort in viral illnesses 3
• The effect is temporary (4-6 hours), so regular dosing may be required during the febrile period 4

However, it's important to note that:

• Paracetamol is intended to reduce fever and improve comfort, not to completely normalize body temperature 4
• Fever typically peaks around 5 days after exposure to infection, and paracetamol's effect is temporary 4

Safety Profile in Viral Fever

Paracetamol has several advantages over other antipyretics:

• It has minimal anti-inflammatory effects, which is beneficial as inflammation is part of the body's defense mechanism against viral infections
• It does not affect platelet function, making it safer than NSAIDs in patients with bleeding tendencies
• It has fewer gastrointestinal side effects compared to NSAIDs 1

Special Considerations

• Liver disease: Despite theoretical concerns, paracetamol can be used safely at recommended doses even in patients with chronic liver disease 5
• COVID-19: In COVID-19 patients with fever, paracetamol is specifically recommended for temperature control 1
• Persistent fever: Fever that persists >3 days despite paracetamol requires further investigation, especially if temperature exceeds 39°C for >10 hours 4

Dosing Guidelines

• Adults: 500-1000 mg every 4-6 hours, not exceeding 4000 mg in 24 hours
• Children: 10-15 mg/kg every 4-6 hours, not exceeding 4 doses in 24 hours 6

Comparison with NSAIDs

While both paracetamol and NSAIDs (like ibuprofen) are effective for fever control:

• Paracetamol is generally considered first-line due to its favorable safety profile
• For bacterial fever, a combination of paracetamol and ibuprofen may be more effective than paracetamol alone in the first hour of treatment 3
• For viral fever specifically, paracetamol alone is usually sufficient and recommended 1

In conclusion, paracetamol is an appropriate and recommended treatment for viral fever, with oral administration being the preferred route in most clinical scenarios. While it won't eliminate the fever completely, it effectively reduces temperature and improves patient comfort with minimal risks.