Management of fever
Fevers are usually treated when a child is in discomfort.
This applies to both children and adults. It’s also important to remember that fever is a sign that something else is going on in the body and that treating it does not treat the underlying cause of the fever.1,2
However, in children < 3 months old, a temperature > 38°C and other “red flag” symptoms should be seen by a doctor.2,3
Managing fever in adults
Assessment of fever in adults2,4,5
To determine if a patient has fever, the most common route of taking a temperature in adults is a thermometer placed under the tongue (oral route).
If the temperature is > 38°C, consider that the patient is febrile.
Don’t forget to ask the patient for other symptoms to determine cause of the fever, “red flag” symptoms and if they require any other treatment recommendations other than medicines for fever.
Non-pharmacological management of fever5
Adult patients may be recommended to do the following to help reduce feeling uncomfortable during a fever:
Keeping hydrated by drinking plenty of fluids
Water and juices will help recover the fluid loss and combat dehydration usually accompanying a fever
Taking rest will help the body recover while heavy or strenuous activity would increase the body temperature further Dressing in light clothing and keeping the room temperature cool may also help
Pharmacological management of fever5-11
A low-grade fever in an adult does not require any medication. However, if the patient is feeling uncomfortable or has a high fever then over-the-counter antipyretics can be recommended. The two most common are paracetamol or ibuprofen, which is a non-steroidal anti-inflammatory (NSAIDs).
Before recommending a treatment, check with your patient to see if there are any precautions and contraindications for taking the medicines such as:
May recommend paracetamol if
May recommend NSAIDs if
There is increased risk of bleeding when on certain drugs e.g. acetylsalicylic acid (aspirin), warfarin, corticosteroids, other medications containing NSAIDs
Currently on certain antihypertensive drugs e.g. angiotensin converting enzyme inhibitors, angiotensin II receptor blockers or diuretics
Having chronic kidney disease (less risk with paracetamol but dose should not be > 3 g/day over long duration)
Peptic ulcer disease
There is increased risk of paracetamol toxicity such as currently on certain epilepsy medications (e.g. carbamazepine) or alcohol abuse
Managing fever in children
Assessment of fever in children12,13
Temperature taken rectally is the recommended method of assessing fever in children up to 3 years old. For children older than 3 years, other methods of taking a temperature are orally (under the tongue), under the armpit or in the ear. However the later two are less accurate.12,13
As with adults, assess for other symptoms accompanying the fever as well as “red flag” symptoms that would require a referral to a doctor.12,13
Non-pharmacological management of fever 1
Parents of children with fever may be recommended to do the following when their child has a fever:1
Dressing the child light as, excess clothing traps body heat causing the temperature to rise Encourage the child to drink plenty of fluids such as juices or even eat popsicles Giving the child a lukewarm bath Placing cold washcloths over certain areas of the body such as the forehead, groin and wrist
Pharmacological management of fever 12,14
The general recommendations for managing fever in children are that infants < 3 months old with a fever of ≥ 38°C should be seen by a doctor regardless of other signs and symptoms whilst children > 3 months old can be observed and/or treated with over-the-counter medications unless exhibiting any “red flag” symptoms.
Treatment with medicines should only be recommended if the child’s temperature is > 38.9°C or at a lower temperature if he/she seems uncomfortable.
Among the medicines available for fever, paracetamol is the recommended first-line treatment for fever in children as it is effective in reducing fever and is gentle on children’s stomach.
How do they present?
Refresh your knowledge on the signs and symptoms of fever and learn about “red flag” symptoms that indicate a referral to the doctor.
An Updated Review and Meta-Analysis on Combined/Alternating Use of Ibuprofen and Paracetamol in Febrile Children
Managing children’s fever and pain
Tailor made for pharmacists, this tool is an excellent guide to help you manage children with fever or pain.