What are the guidelines for managing fever?

Guidelines for Management of Fever

Fever should be treated primarily for comfort rather than temperature reduction alone, with acetaminophen (paracetamol) as the preferred antipyretic medication. 1

Temperature Measurement

• Central temperature monitoring methods (pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors) are preferred when available or when accurate temperature measurements are critical 2, 1
• For patients without central monitoring devices, oral or rectal temperatures are recommended over less reliable methods such as axillary or tympanic measurements 2
• Tympanic membrane thermometers and temporal artery thermometers show poor agreement with core temperature measurements and should not be relied upon for critical decision-making 2, 1

Pharmacological Management

General Approach

• Antipyretic medications should not be routinely used for the specific purpose of reducing temperature alone, as this has not been shown to improve mortality outcomes 2, 1
• Antipyretics should be used primarily to promote comfort in febrile patients 2
• When antipyretics are used, acetaminophen (paracetamol) is the preferred first-line agent 2, 1
• Antipyretic dosing should be based on the child's weight rather than age 3
• Combined or alternating use of antipyretics is discouraged 3

Special Considerations

• In children with febrile seizures, antipyretic treatment should focus on comfort rather than prevention of seizures 2
• Ibuprofen is not recommended in febrile children with chickenpox or dehydration 3
• Use of ibuprofen or acetaminophen is not contraindicated in febrile children with asthma 3
• Newborns with fever should always be hospitalized due to elevated risk of severe disease 3

Non-Pharmacological Management

• Physical cooling methods such as fanning, cold bathing, and tepid sponging are not recommended as they cause discomfort, especially in children 2, 4
• Tepid sponging alone results in only short-term temperature reduction and causes more discomfort than antipyretics 4, 5, 6
• Maintaining adequate hydration is important during febrile episodes 2, 1, 4
• For patients who value comfort through temperature reduction, antipyretic medications are preferred over non-pharmacological cooling methods 2, 1

Diagnostic Approach

• For patients who develop fever during ICU stay, a chest radiograph is recommended as part of the initial workup 2
• In patients with recent thoracic, abdominal, or pelvic surgery, CT scanning should be performed if an etiology is not readily identified by initial workup 2
• Blood glucose measurement with a glucose oxidase strip is recommended in any child who is still convulsing or unrousable when seen with fever 2
• Lumbar puncture should be performed in children with fever if there are clinical signs of meningism, after a complex convulsion, if the child is unduly drowsy or irritable, or if the child is aged less than 18 months (particularly under 12 months) 2

Common Pitfalls to Avoid

• Treating the number on the thermometer rather than the patient's symptoms and comfort 1
• Using unreliable temperature measurement methods (tympanic, temporal) for critical decisions 2, 1
• Failing to identify and treat the underlying cause of fever 2, 1
• Using physical cooling methods that cause discomfort, especially in children 2, 4
• Administering antipyretics with the sole purpose of preventing febrile seizures, as this has not been proven effective 3, 7