What is the best course of treatment for a patient with fever?

Treatment of Fever

For most patients with fever, antipyretic treatment should be reserved only for those experiencing significant discomfort, rather than treating fever based on temperature threshold alone, as fever is an evolved immune defense mechanism that likely improves outcomes. 1

When to Treat Fever

Treat based on discomfort, not temperature:

• Administer antipyretics (acetaminophen or ibuprofen) only when fever causes discomfort or distress, regardless of the specific temperature reading 2
• Avoid routine antipyretic use simply because a temperature threshold is reached, as fever enhances immune cell performance and provides direct stress to pathogens 1
• The evidence for any specific temperature threshold to initiate treatment is very low quality, and guidelines vary widely on this fundamental question 3

Special Populations Requiring Different Approaches

Newborns and infants <4 weeks:

• Always hospitalize febrile newborns due to elevated risk of severe bacterial infection 2
• Acetaminophen may be used with dose adjusted to gestational age 2

Children with specific conditions:

• Avoid ibuprofen in febrile children with chickenpox or dehydration 2
• Ibuprofen and acetaminophen are not contraindicated in children with asthma 2
• Exercise caution in severe hepatic/renal failure or severe malnutrition 2

Cancer patients:

• Fever requires urgent evaluation to determine infectious versus noninfectious causes to minimize morbidity and mortality 4
• The threshold for concern is lower given immunocompromised status 4

Choice of Antipyretic Agent

Use single-agent therapy:

• Choose either acetaminophen (paracetamol) OR ibuprofen as monotherapy 2
• Dose based on weight rather than age 2
• Avoid combined or alternating use of multiple antipyretics 2
• For acetaminophen, oral administration is preferable to rectal when possible 2

What NOT to Do

Avoid these common practices:

• Do not use physical cooling methods (tepid sponging, cooling blankets) except in true hyperthermia (not fever) 2
• Do not give antipyretics to prevent febrile convulsions—this is ineffective 2
• Do not give antipyretics to prevent vaccine adverse effects—this is ineffective 2
• Do not routinely suppress fever in COVID-19 or other infections, as blocking fever may be harmful by interfering with evolved immune defenses 1

The Rationale: Why Fever Should Often Be Left Alone

Fever provides survival benefit:

• Observational trials in humans suggest survival benefit from allowing fever to run its course 1
• Randomized trials published before COVID-19 do not support routine fever reduction in infected patients 1
• Fever augments immune cell performance and induces direct stress on pathogens and infected cells 1
• The precautionary principle applies: unless evidence suggests harm, fever should be allowed to occur 1

Common Pitfall

The most significant pitfall is "fever phobia"—the reflexive treatment of any elevated temperature. This practice lacks evidence for improved outcomes and may interfere with beneficial immune responses 1, 3. Focus treatment decisions on patient comfort and specific clinical contexts (newborns, immunocompromised patients) rather than arbitrary temperature cutoffs.