Should paracetamol (acetaminophen) still be given to a patient with a recurring normal body temperature?

Should Paracetamol Be Given for Temperature of 37.5°C?

FALSE - Do not give paracetamol for a temperature of 37.5°C (99.5°F), as this is within the normal range and does not meet the threshold for fever treatment.

Temperature Threshold for Paracetamol Administration

The most recent and highest-quality guidelines establish clear temperature thresholds for antipyretic therapy:

• Fever is defined as temperature >37.7°C (99.9°F) according to the 2022 European Resuscitation Council guidelines 1
• Treatment threshold is temperature >37.5°C (99.5°F) per the 2021 American Heart Association stroke nursing guidelines 2
• The 2022 ILCOR consensus specifically used 37.5°C as the cutoff, with cooling devices only initiated when temperature exceeded 37.7°C 2

Clinical Reasoning for This Case

In your specific scenario:

• Initial temperature: 37.5°C - This is at the borderline threshold
• Post-paracetamol temperature: 37.2°C - This demonstrates the medication worked and temperature normalized
• Afternoon temperature: 37.5°C - This returns to the threshold but does not exceed it

The temperature of 37.5°C does not constitute fever requiring treatment 2. This represents normal physiological variation in body temperature throughout the day, as core temperature naturally fluctuates.

Evidence-Based Temperature Management Protocol

The FeSS (Fever, Sugar, Swallowing) protocol, validated in stroke patients but applicable broadly, provides the clearest guidance 2:

• Monitor temperature at least 4 times daily for 3 days 2
• Treat only when temperature exceeds 37.5°C (99.5°F) with paracetamol unless contraindicated 2
• This protocol demonstrated 16% reduction in mortality and dependency when properly implemented 2

When to Actually Administer Paracetamol

Paracetamol should be given when:

• Temperature exceeds 37.5°C (99.5°F) 2
• Temperature reaches 37.7°C (99.9°F) or higher for more conservative fever prevention strategies 2, 1
• Patient experiences discomfort from fever 2

Important Clinical Caveats

Do not routinely give antipyretics to normothermic patients (temperature <38°C) as prophylaxis, as this has not been shown to improve outcomes 2. The European Stroke Organisation guidelines specifically recommend against routine prevention of hyperthermia with antipyretics in normothermic patients 2.

Paracetamol's mechanism is antipyretic, not temperature-lowering in normal states 3. It works by inhibiting prostaglandin synthesis in the CNS during fever states, but has minimal effect on normal thermoregulation 3, 4.

Maximum effect occurs 2-4 hours after administration 5, so reassessing temperature shortly after a dose may not reflect full therapeutic effect.

Practical Algorithm

1. Temperature ≤37.5°C: Monitor only, no paracetamol 2
2. Temperature 37.6-37.7°C: Consider paracetamol if patient symptomatic or trending upward 2, 1
3. Temperature >37.7°C: Administer paracetamol 2, 1
4. Temperature >38.5°C with persistent fever: Consider adding ibuprofen or physical cooling methods 5

In your case, the afternoon temperature of 37.5°C does not warrant paracetamol administration - continue monitoring and only treat if temperature rises above this threshold 2.