What is the treatment for fever?

Treatment of Fever

For patients with fever, antipyretic medications should be used when the goal is to improve patient comfort, rather than routinely administering them for the sole purpose of reducing temperature. 1

Diagnostic Approach

• Fever is a physiologic mechanism that has beneficial effects in fighting infection rather than being a primary illness itself 2, 3
• Central temperature monitoring methods (thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors) provide the most accurate measurements when precision is critical 1
• Tympanic membrane thermometers and temporal artery thermometers may be influenced by environmental temperature and sweating, and should not be relied upon 1
• Blood cultures should be obtained before initiating antimicrobial therapy, especially if the patient is seriously ill or deteriorating 2
• A chest radiograph is recommended for patients who develop fever during ICU stay 1

Pharmacologic Treatment

• Antipyretic medications are the first-line therapy for fever when treatment is indicated for patient comfort 1
• Paracetamol (acetaminophen) 1000 mg is commonly used as first-line treatment for fever in emergency settings 4
• The combination of paracetamol 500 mg/ibuprofen 150 mg may be more effective than paracetamol alone in patients with bacterial fever at one hour after administration 4
• For influenza-associated fever, oseltamivir has been shown to reduce the median time to improvement by 1.3 days compared to placebo when started within 40 hours of symptom onset 5
• In critically ill patients, antipyretic medications are preferred over nonpharmacologic methods when the goal is to reduce body temperature for comfort 1

Special Considerations

Critically Ill Patients

• Routine use of antipyretic medications for the specific purpose of reducing temperature in critically ill patients with fever is not recommended 1
• For critically ill patients who value comfort by reducing temperature, antipyretic medications are suggested over nonpharmacologic methods 1
• Fever management in critically ill patients has not been shown to improve 28-day mortality, hospital mortality, or shock reversal 1

Infectious Causes of Fever

• For suspected bacterial infections, empiric antimicrobial therapy should be initiated when clinical evaluation suggests infection is the cause of fever, especially if the patient is seriously ill 2
• Begin antimicrobial therapy within 1 hour after the diagnosis of sepsis is considered 2
• For enteric fever, ceftriaxone is preferred as first-line agent for patients returned from areas with high fluoroquinolone resistance 1
• For influenza, oseltamivir treatment (75 mg twice daily for 5 days) can reduce fever duration and symptom improvement time 5

Fever in Children

• The primary goal of treating febrile children should be to improve overall comfort rather than normalizing body temperature 6
• Both acetaminophen and ibuprofen are considered safe and effective for fever management in generally healthy children 6

Common Pitfalls and Caveats

• Treating fever with antipyretics may interfere with the body's natural defense mechanisms against infection 3
• Many parents administer antipyretics even with minimal or no fever due to misconceptions about fever's dangers 6
• There is no evidence that fever itself worsens the course of illness or causes long-term neurologic complications 6
• Empiric antimicrobial therapy has not been shown to be effective in the treatment of fever of unknown origin and should be avoided except in patients who are neutropenic, immunocompromised, or critically ill 7
• When treating fever in critically ill patients, it's important to recognize that fever reduction has not been shown to improve mortality outcomes 1