The
objectives in treating fever are first to reduce the elevated hypothalamic set
point and second to facilitate heat loss. There is no evidence that fever
itself facilitates the recovery from infection or acts as an adjuvant to the immune
system. In fact, peripheral PGE2 production is a potent immunosuppressant. Hence,
treating fever and its symptoms does no harm and does not slow the resolution
of common viral and bacterial infections. Reducing fever with antipyretics also
reduces systemic symptoms of headache, myalgias, and arthralgias. Oral aspirin
and NSAIDs effectively reduce fever but can adversely affect platelets and the
gastrointestinal tract. Therefore, acetaminophen is preferred to all of these
agents as an antipyretic. In children, acetaminophen must be used because
aspirin increases the risk of Reye’s syndrome. If the patient cannot take oral
antipyretics, parenteral preparations of NSAIDs and rectal suppository
preparations of various antipyretics can be used. Treatment of fever in some
groups of patients is recommended. Fever increases the demand for oxygen (i.e.,
for every increase of 1˚C over 37˚C,
there is a 13% increase in oxygen consumption) and can aggravate preexisting
cardiac, cerebrovascular, or pulmonary insufficiency. Elevated temperature can
induce mental changes in patients with organic brain disease. Children with a
history of febrile or nonfebrile seizure should be aggressively treated to
reduce fever, although it is unclear what triggers the febrile seizure and
there is no correlation between absolute temperature elevation and onset of a
febrile seizure in susceptible children.
In hyperpyrexia, the use of cooling blankets facilitates the reduction of
temperature; however, cooling blankets should not be used without oral
antipyretics. In hyperpyretic patients with CNS disease or trauma, reducing
core temperature mitigates the ill effects of high temperature on the brain.
Source: Harrison_s_Principles_of_Internal_Medicine_16th_Edition
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