Antipyresis and Fever

doi:10.1001/archinte.1990.00040031589005

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Vol. 150 No. 8, August 1990

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Antipyresis and Fever

Barbara Styrt; Barrett Sugarman

Arch Intern Med. 1990;150(8):1589-1597.

Abstract

While understanding of the mechanisms of fever has progressedin recent years, much uncertainty remains as to whether feverin itself (as distinct from its cause) is beneficial or harmful,and what circumstances warrant antipyretic therapy. This reviewwas designed to identify studies providing information on theeffects of fever and of pharmacologic and physical therapy.Fever or analogous behavioral thermal upregulation apparentlyhas positive effects on defense against infection in some animalmodels. Retrospective studies in humans suggest that failureto mount a febrile response is associated with poor outcomein certain infections but do not establish a causal relationship.Induction of fever apparently had therapeutic value in infectionssuch as syphilis before specific antimicrobials were developed.Fever may have deleterious effects in the context of borderlinecardiovascular or neurologic function or pregnancy, but datain most instances cannot separate effects of fever per se fromthat of underlying disease. Antipyretic drugs are effectivein diminishing fever, but they have significant side effectsand may suppress signs of ongoing infection. Physical coolingis important when physiologic thermoregulatory mechanisms areoverwhelmed, but may sometimes increase discomfort and metabolicstress in fever. Antipyretic therapy should not be institutedroutinely for every febrile episode but should be based on evaluationof relative risks in the individual case and reassessed if anticipatedbenefits are not achieved.

(Arch Intern Med. 1990;150:1589-1597)

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