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Consider Risks Before Treating Fever

Katherine M. Bennett

Health care professionals and the public almost instinctively try to suppress a fever, but no one has firmly established that the benefits of antipyretic therapy outweigh its risks.

In a review published in the Feb. 28 issue of Archives of Internal Medicine, Karen I. Plaisance, Pharm.D., and Philip A. Mackowiak, M.D., critically evaluated the physiologic rationale, diagnostic implications, and clinical consequences of antipyretic drugs and external cooling. They noted that "it has never been shown in humans that increases in core temperature encountered during fever, which rarely exceed 41 degrees C (105.8 degrees F), are harmful per se." 

Although the authors did not delve into a numeric definition of fever, they offered the following evidence-based recommendations for appropriately using antipyretic therapy 

  • Short courses of standard antipyretic therapy, given at dosages mentioned in the package labeling, have a low risk of toxic effects,     
  • Standard antipyretic therapy, if not otherwise contraindicated (for example, aspirin for young children), can be used to relieve symptoms in patients with fever or reduce the metabolic demands of fever in chronically debilitated patients     
  • To minimize drug-induced fluctuations in temperature, antipyretic agents should be used at regular intervals, not "as needed," and     
  • Nonsteroidal anti-inflammatory agents should be used with caution, if at all, by patients with coronary artery disease.

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