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Feature Article

Fever in adults: keys to rational management

Paul Preisz, David Wise

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Abstract

It is often assumed that a patient presenting with a fever should be treated, regardless of the presence or absence of any other symptoms. However, the evidence that antifever treatments lead to an improvement in morbidity or mortality – or even patient comfort – is somewhat lacking.

Key Points

  • Fever is often misunderstood by patients and healthcare workers. The fever response to infection may be an evolutionary adaptation that could actually be beneficial.
  • Normal core body temperature is 370.8oC, and varies with circadian rhythm, the menstrual cycle, and the method of measurement. This variation must be taken into account when interpreting a measured temperature.
  • A fever greater than 40oC should prompt the clinician to exclude a specific hyperpyrexial syndrome.
  • A fever associated with a specific underlying illness is managed by treating that illness.
  • Treatment of a fever per se is indicated if the hypermetabolic demands imposed on the patient by the fever are excessive.
  • Pharmacological antifever measures should be used before physical measures; the latter can then be added, if necessary.
  • There is no evidence definitively supporting the use of paracetamol combined with an NSAID to reduce fever. Either paracetamol or an NSAID can be used alone.

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