First-Line Treatment for Fever
Acetaminophen (paracetamol) is the first-line treatment for fever in both children and adults due to its effectiveness and favorable safety profile. 1, 2
Antipyretic Medications
- Acetaminophen (paracetamol) is recommended as the first-line antipyretic for fever reduction in both adults and children 1, 2
- Ibuprofen is an effective alternative antipyretic, particularly in children, with some studies suggesting it may have a slightly longer duration of action 3, 4
- For children, acetaminophen should remain the first-line therapy for childhood fever due to its comparable antipyretic efficacy and superior tolerability profile 4
Treatment Approach
- Antipyretic medications should be used primarily for patient comfort rather than simply to reduce temperature 5, 6
- Physical cooling methods such as fanning, cold bathing, and tepid sponging are not recommended as they may cause discomfort 5
- Adequate fluid intake should be ensured during febrile episodes to prevent dehydration 5
Special Considerations
- In critically ill patients, routine use of antipyretics solely for temperature reduction is not recommended unless the patient values comfort by reducing temperature 5, 6
- For patients with acute ischemic stroke, prompt fever treatment is recommended to prevent worse outcomes 5, 6
- In children with febrile convulsions, fever should be treated to promote comfort and prevent dehydration, with paracetamol being the preferred agent 5
Combined or Alternating Therapy
- There is some evidence that combined or alternating acetaminophen and ibuprofen therapy may be more effective at reducing temperatures than monotherapy alone 7
- However, evidence for improvements in patient comfort with combined therapy remains inconclusive 7
- When using both medications, careful recording of dose times is essential to avoid accidentally exceeding maximum recommended doses 3
Monitoring and Follow-up
- For temperature monitoring, central methods (pulmonary artery catheters, bladder catheters, esophageal thermistors) are most accurate when available 5, 6
- When central monitoring is unavailable, oral or rectal temperatures are preferred over less reliable methods like axillary or tympanic measurements 5, 6
- In critically ill patients with fever, a chest radiograph is recommended as part of the diagnostic workup 5
Potential Risks and Considerations
- Acetaminophen overdose can cause acute hepatic failure, so proper dosing is essential 2
- Aspirin (acetylsalicylic acid) should be avoided in children with fever due to its association with Reye syndrome 4, 2
- The routine use of antipyretics in all febrile patients has been questioned, as fever may play a beneficial role in the body's natural defense mechanisms 8