What is the treatment for fever?

Treatment of Fever

For most patients with fever, antipyretic medications should be used only when comfort is a priority rather than routinely for the purpose of reducing temperature, as fever is a beneficial physiologic mechanism in fighting infection. 1, 2

Understanding Fever as a Defense Mechanism

• Fever is not a primary illness but a physiologic mechanism with beneficial effects in fighting infection, augmenting immune cell performance and inducing stress on pathogens 3, 2
• There is no evidence that fever itself worsens the course of illness or causes long-term neurologic complications 3
• Observational trials suggest a survival benefit from fever, and randomized trials do not support routine fever reduction in patients with infection 2

Recommended Approach to Fever Management

Initial Assessment

• Determine whether fever represents initial onset, persistent unexplained fever (after 4-7 days), or a recurrent episode 4
• For accurate temperature measurement in critically ill patients, central temperature monitoring methods (thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors) are preferred 1
• Obtain blood cultures before initiating antimicrobial therapy, especially if the patient is seriously ill or deteriorating 4

Treatment Recommendations

• For critically ill patients with fever, avoid routine use of antipyretic medications solely for temperature reduction 1
• For patients who prioritize comfort, antipyretic medications are preferred over non-pharmacologic methods 1
• Common antipyretic options include:
  • Acetaminophen (paracetamol) 1000 mg 5
  • Combination of paracetamol 500 mg/ibuprofen 150 mg (particularly effective for bacterial fever) 5

Special Considerations

• In influenza treatment, oseltamivir can reduce fever duration by approximately 1.3 days when started within 40 hours of symptom onset 6
• For patients with enteric fever (typhoid), ceftriaxone (50-80 mg/kg/day, maximum 2g/day) is recommended as first-line parenteral therapy in areas with high fluoroquinolone resistance 7
• For neutropenic fever, prompt empiric antibacterial therapy is essential 4

Evidence on Effectiveness

• A 2023 study found no significant difference between paracetamol 1000 mg and paracetamol/ibuprofen 500/150 mg combination in overall fever reduction after two hours (90.5% vs 91.9%) 5
• However, the combination was more effective for bacterial fever at one hour (48.6% vs 33.6%) 5

Important Caveats

• Antipyretic medications should not be administered solely to normalize body temperature 3
• Empiric antimicrobial therapy has not been shown effective for fever of unknown origin and should be avoided except in neutropenic, immunocompromised, or critically ill patients 8
• For fever of unknown origin (persisting daily fever for more than two weeks), a systematic diagnostic approach is necessary as approximately half of cases have an infectious cause 9

Monitoring Recommendations

• Monitor the patient's general well-being and activity level rather than focusing exclusively on temperature normalization 3
• Observe for signs of serious illness, encourage appropriate fluid intake, and ensure safe storage of antipyretics 3
• For patients with stroke and fever, maintain glucose in the range of 140-180 mg/dL and promptly treat hypoglycemia (<60 mg/dL) 1