Can I give paracetamol to my relative who has a fever of 38.6 °C?

Should You Give Paracetamol for a Temperature of 38.6°C?

Yes, you can give paracetamol to your relative with a fever of 38.6°C, particularly if they are experiencing discomfort or pain alongside the fever. However, fever alone does not necessarily require treatment unless it is causing distress.

When Paracetamol Is Indicated

• Paracetamol is most appropriate when fever is accompanied by discomfort or pain, as it provides effective relief for both symptoms 1, 2.
• The standard adult dose is 650-1000 mg orally every 4-6 hours, with a maximum of 4 grams (4000 mg) per day 3.
• Paracetamol's antipyretic effect begins within hours but may take up to 4 hours to reach maximum effect, so patience is needed after administration 3, 4.

Important Context About Fever Treatment

Fever itself is not inherently dangerous and serves a protective physiological role 5. The evidence shows:

• In patients with infection, outcomes may actually be better with modest fever (38-38.4°C or even 39-39.4°C in some databases) compared to aggressive temperature reduction 5.
• Fever inhibits replication of certain bacteria like N. meningitidis and S. pneumoniae and helps with diagnosis of infection 5.
• In septic patients, paracetamol decreases temperature by only 0.3°C and does not affect mortality or ICU length of stay 5.

Clinical Decision Algorithm

Give paracetamol if:

• Your relative is uncomfortable, has pain, or is distressed by the fever 1, 2
• The fever is interfering with rest or quality of life 1

Consider withholding paracetamol if:

• The fever is well-tolerated without significant discomfort 2
• There is suspected infection where fever may be beneficial 5

If Fever Persists After Paracetamol

• If temperature remains above 38°C after 4 hours, paracetamol may be less effective at higher temperatures 4.
• Consider adding ibuprofen (an NSAID) as second-line therapy if fever persists and causes ongoing discomfort 4.
• Encourage fluid intake up to 2 liters daily to prevent dehydration 4.
• Physical cooling methods like tepid sponging can be added 4.

Critical Safety Considerations

• Do not use paracetamol with any other drugs containing acetaminophen to avoid accidental overdose 6.
• Do not exceed the maximum recommended dose of 4 grams per day in adults 3.
• Single ingestions of more than 10 times the recommended dose are potentially hepatotoxic 1.
• If your relative is allergic to acetaminophen, do not use it 6.

When to Seek Medical Attention

Escalate care if:

• Fever persists despite combined pharmacological and physical cooling methods 4
• Signs of clinical deterioration develop 4
• Concerning symptoms appear such as altered mental status, severe headache, neck stiffness, or respiratory distress 4