Management of Fever

“Fever is nature’s engine which she brings into the field
to remove her enemy.”

Thomas Sydenham

When to treat a fever?

  • All fever cases should be treated appropriately.
  • Following signs should be assessed and require thorough assessment:
    • A temperature above 104°F or lower than 95°F
    • Rash over the body
    • Stiff neck and rigidity
    • Low blood pressure
    • Tachycardia or tachypnea/dyspnea
    • Altered sensorium
    • Fever not subsiding after 3-5 days

Reference: Bush LM. Fever in adults. MSD Manual. Sep 2022. Accessed on Nov 2, 2022, from https://www.msdmanuals.com/en-in/home/infections/biology-of-infectious-disease/fever-in-adults

Treatment strategy

The primary goal: Relieve the discomfort commonly associated with fevers by reducing temperature to normal body temperature.

Reference:Stepwise guide for diagnosis and management of acute fever in primary care. Accessed on November 2, 2022, from https://www.ima-india.org/ima/pdfdata/Treatment-Algorithm-Flip-Chart-03122021.pdf

Role of anti-pyretics in fever

  • The most commonly preferred anti-pyretics are Paracetamol, Mefenamic Acid, Ibuprofen, etc.

Ideal anti-pyretic

  • An anti-pyretic which offers relatively fast and a longer duration of temperature reduction providing necessary comfort (symptom reductions like – body ache, headache, myalgia and improving sleep quality).

Mefenamic Acid as an anti-pyretic

  • Mefenamic Acid, a non-steroidal anti-inflammatory drug (NSAID), has an established anti-pyretic, anti-inflammatory and analgesic effect.
  • Mefenamic Acid has dual site of action, both central and peripheral inhibition of PG synthesis.
  • Mefenamic Acid is unique due to its dual mode of actions- inhibition of PG synthesis and blockage of E-type prostanoid (EP) receptors.
  • Additionally it has also been found to possess a novel inhibitory action on the NLRP3 inflammasome.
  • As compared to Paracetamol and Ibuprofen, Mefenamic Acid has been demonstrated to achieve superior 24 hours temperature reduction.

Mefenamic Acid vs. other anti-pyretics

  • Mefenamic Acid has both central and peripheral action, whereas, Paracetamol has only central action.
  • Mefenamic Acid is unique in blocking the EP receptors which is not possessed by other NSAIDs (Non-steroidal anti-inflammatory drugs) including Paracetamol.
  • Besides, it has a novel inhibitory action on NLRP3 inflammasome which helps in attenuating fever and inflammation effectively; whereas the same is not the case with Paracetamol, Ibuprofen and Nimesulide.
  • As compared to Paracetamol, Mefenamic Acid has been found to demonstrate better antipyresis at 1 hour.
  • Mefenamic Acid exhibits a comparable anti-inflammatory effect to Ibuprofen, according to studies.
  • Comparing Mefenamic Acid to Paracetamol and Ibuprofen, the former has greater efficacy and tolerability. While Nimesulide and Mefenamic Acid have comparable anti-inflammatory, anti-pyretic, and analgesic efficacy, Nimesulide may cause fulminant hepatitis.

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