Managing Fever with Antipyretics

Fever can be a sign of a serious underlying illness and can be treated with antipyretics or nonpharmacologic measures.

Although fever can typically be easily managed with proper treatment, it may also be an indication of a serious underlying illness, such as an acute infection, that requires immediate evaluation and treatment. ² The majority of fevers are caused by microbial infections, including bacterial, viral, fungal, and yeast infections, but they can also be the result of vigorous activity or a response to certain pharmacologic agents (also known as a drug fever). ^2-5

Detecting Fevers

Patients should be advised to use a reliable thermometer to obtain an accurate temperature reading and to adhere to manufacturer-recommended procedures. Digital thermometers are the most widely used measuring devices and are available with a variety of features. Temperatures can be measured orally, tympanically, rectally, temporally, or under the arm. ^2,6

A rectal thermometer is preferred for measuring temperature in patients up to 6 months of age. ² A tympanic thermometer is not recommended for those younger than 6 months because of the shape and size of the infant ear. ² A rectal thermometer is also preferred for patients aged 6 months to 5 years, but oral, tympanic, or temporal thermometers may be used in this age group if proper technique is employed. In patients older than 5 years, oral, tympanic, or temporal thermometers can be used. ²

Treating Fever

Relieving discomfort and reducing body temperature to a normal level are both goals in treating fever, but it is also important to identify and treat the fever’s underlying cause.^1-3 Fever treatment includes the use of various OTC antipyretics as well as a host of nonpharmacologic measures.

Available OTC antipyretics include acetaminophen and the nonsteroidal anti-inflammatory drugs aspirin, ibuprofen, and naproxen. Acetaminophen and ibuprofen are the 2 most widely used antipyretics.^2,4 Ibuprofen is only approved for fever reduction in patients 6 months and older, however.² These products are available as single-entity or combination products in extendedrelease versions and come in a variety of forms, including tablets, capsules, gel capsules, liquid gels, enteric coated, liquids, suspensions, and chewable tablets for adult and pediatric patients.

Using OTC Products Safely

Due to concerns about inaccurate dosing of liquid medications, the FDA released guidelines for liquid nonprescription drugs in May 2011. The key recommendations include:⁷

• Dosage delivery devices should be included for all orally ingested OTC liquid drug products.
• Devices should be marked with calibrated units of liquid measurement (eg, teaspoon, tablespoon, or milliliter) that are the same as the units of liquid measure specified in the directions for the product—and there should be no unnecessary markings.
• Manufacturers should ensure that dosage delivery devices are used only with the products with which they are packaged.
• Liquid measure markings on dosage delivery devices should be clearly visible and not obscured when the liquid product is added to the device.

On February 28, 2011, the American Academy of Pediatrics issued a statement regarding management of fevers in pediatric patients, including the following recommendations: Although many parents give children antipyretics such as acetaminophen or ibuprofen to reduce fever, the primary goal should be to help the child feel more comfortable, rather than to maintain a “normal” temperature.⁵ Parents should focus on the child’s general well-being by monitoring them for signs of serious illness and ensuring adequate intake of fluid to avoid dehydration.⁵

In addition, caregivers should not wake a sleeping child to administer a fever reducer and should store antipyretics safely and out of children’s reach to avoid accidental ingestion.⁵ Antipyretic dosage for children should be based on the patient’s weight, and an accurate measuring device should always be used.⁵ Parents should be encouraged to discuss any uncertainties regarding dosage and use of antipyretics with their primary health care provider.⁵

The report also addresses the common practice of alternating or combining acetaminophen and ibuprofen to control fever, concluding that current evidence suggests that there is no substantial difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever.⁵ The report notes that there is evidence that combining these 2 products is more effective than using a single agent alone; however, there are many concerns that combined treatment may be more complicated and contribute to the unsafe use of these pharmacologic agents, which may increase the risk of overdose and medication errors.^2,5 Pediatricians should also promote patient safety by promoting simplified formulations and counseling patients on dosing instructions and dosing devices.^2,5

Final Thought

In general, antipyretics take 30 to 60 minutes after administration to decrease temperature and discomfort.² Nonpharmacologic measures such as maintaining adequate fluid intake to replenish lost body fluids, wearing lightweight clothing, and maintaining a comfortable room temperature should also be incorporated into treatment.² During counseling, pharmacists should ensure that patients and caregivers understand proper use of antipyretic products, including dosing, administration, and possible adverse effects. Because antipyretics can also be found in many cough, cold, and flu products, patients should be advised to always read medication labels prior to administering to avoid therapeutic duplications or possible medication overdose. In addition, if unsure about correct dosing, especially for pediatric patients, caregivers should always contact their primary health care provider for advice.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

• Definition of fever. Medical Dictionary.com. http://medical-dictionary.thefreedictionary.com/fever. Accessed August 1, 2012.
• Feret B. Fever. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.
• Facts about fevers. NIH News website. http://newsinhealth.nih.gov/2009/March/feature2.htm. Accessed August 1, 2012.
• Fever. Merck Manual for Health Care Professionals website. www.merckmanuals.com/professional/infectious_diseases/biology_of_infectious_disease/fever.html. Accessed August 1, 2012.
• Sullivan JE, Farrar HC; the Section on Clinical Pharmacology and Therapeutics, Committee on Drugs. Fever and antipyretic use in children. Pediatrics. 2011;127(3):580-587.
• How to take your child’s temperature. Pfizer’s Advil website. http://childrens.advil.com/how-to-take-your-childs-temperature. Accessed August 1, 2012.
• FDA issues final guidance for liquid OTC drug products with dispensing devices. FDA website. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm2540210.htm. Accessed August 1, 2012.
• Fever: when to call the doctor. American Academy of Pediatrics’ Healthy Children website. www.healthychildren.org/English/health-issues/conditions/fever/Pages/When-to-Call-the-Pediatrician.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token. Accessed August 1, 2012.