Antipyretic Care at Home During Viral Illness
Use paracetamol (acetaminophen) as the first-line antipyretic for viral illness at home, but only when fever causes discomfort or other symptoms requiring relief—not solely to reduce body temperature. 1
Core Principle: Symptom-Directed Treatment
The most important guideline from NICE is clear: do not use antipyretics with the sole aim of reducing body temperature. 1 This represents a fundamental shift in fever management philosophy. Fever itself may have beneficial effects in fighting viral infections, and routine temperature reduction without considering patient comfort lacks evidence of clinical benefit. 2
Recommended Antipyretic Regimen
First-Line: Paracetamol (Acetaminophen)
- Paracetamol is preferred over NSAIDs for viral illness, particularly COVID-19, until more evidence becomes available. 1
- Adult dosing: 1000 mg every 4-6 hours as needed for fever with associated symptoms (pain, headache, myalgias). 3, 4
- Pediatric dosing: 10-15 mg/kg every 4-6 hours, maximum 5 doses in 24 hours. 5, 6
- Continue only while symptoms of fever AND other symptoms are present—discontinue when patient feels comfortable, even if low-grade fever persists. 1
Alternative: Ibuprofen
- Adult dosing: 400 mg every 4-6 hours as needed, not exceeding 4 doses in 24 hours. 7
- Can be used if paracetamol is contraindicated or ineffective, though paracetamol remains preferred for viral illness. 1
- For bacterial fever specifically, the combination of paracetamol 500 mg/ibuprofen 150 mg showed superior efficacy at 1 hour compared to paracetamol alone. 8
Critical Contraindications
Never use aspirin in children under 16 years of age due to Reye's syndrome risk. 1, 5, 6 This is an absolute contraindication that applies to all fever management in pediatric viral illness.
Supportive Measures Beyond Antipyretics
- Advise regular fluid intake to prevent dehydration, but limit to no more than 2 liters per day. 1
- Maintain body temperature below 38°C as acceptable—much lower temperatures may not be conducive to antiviral response. 1
- For children under 4 years, avoid over-the-counter cold medications without healthcare provider consultation. 1, 5
When Antipyretics Are Indicated
Use antipyretics when fever is accompanied by:
- Significant discomfort or distress 1
- Headache, myalgias, or other pain symptoms 1
- Conditions known to be painful 2
Do NOT use antipyretics for:
- Asymptomatic fever or fever without discomfort 1
- Routine temperature reduction in otherwise comfortable patients 2
Common Pitfalls to Avoid
Treating the thermometer instead of the patient: The goal is symptom relief, not achieving a specific temperature reading. 1
Continuous scheduled dosing: Antipyretics should be used "as needed" for symptoms, not on a fixed schedule throughout the illness. 1
Using NSAIDs as first-line in viral illness: While evidence is still emerging, paracetamol is preferred over NSAIDs for COVID-19 and other viral infections. 1
Combining multiple antipyretics without clear indication: There is limited evidence supporting routine combination therapy in adults, though the paracetamol/ibuprofen combination may have specific utility in bacterial infections. 8
Special Populations
Children
- High fever (>38.5°C) with cough or influenza-like symptoms requires evaluation by a healthcare professional. 1, 5, 6
- Children under 1 year should be assessed by a physician due to higher complication risk. 1, 6
- Acetaminophen remains the preferred antipyretic in pediatric viral illness. 5, 6
Pregnant Women
- Acetaminophen is recommended for fever treatment in pregnancy. 1
- Pregnancy should not be considered a contraindication to acetaminophen use. 1
Evidence Quality Note
The recommendation to avoid antipyretics solely for temperature reduction comes from high-quality NICE guidelines (2020) specifically addressing viral illness management. 1 This guidance prioritizes patient comfort and quality of life over arbitrary temperature targets, which aligns with the lack of evidence showing clinical benefit from routine fever suppression in viral infections. 2