Should we reduce fever?

Fever

So I found myself banging on about kids and fever again last week in a trauma course of all platforms.

The message is slowly getting the through, but where literature focuses on efficacy of paracetamol and ibuprofen, it conclusively agrees on two key points:

1.  that these drugs should be reserved for pain and discomfort .

2.  There is no evidence that they will prevent a febrile convulsion. 

In 2010 the RACGP (college of GPs ) in Australia released a paper redefining what a fever was. Previously a patient was considered to have a fever when there core temperature rose above 37.5 degrees of Celsius. Now it is 38.0.

This was also coupled with the notion that fever should not be treated until at least 39.0. 

A common ignorance in health care providers is that at the slightest hint of a fever, some over the counter antipyretic would be given. The medical world is calling for this nonsense to cease. But it is so hard to sell this message to "out of date" parents, doctors and nurses.

Here it is - as blunt as I can put it. Stop treating fever like it is a bad thing!!

Recognise that fever is the body's normal natural response to fighting an infection.

After invasion by a virus or bacteria, phagocytes coming into contact with pathogens release signalling chemicals called pyrogens which stimulate prostaglandin release. These prostaglandins alter the body thermostat in the hypothalamus. As long as phagocytes are active in killing pathogens, they will release these chemicals to keep the temperature high. It aids in proliferation of immunity compounds and cells to the site of invasion. Fever cures infection .

Now paracetamol, and ibuprofen acting as antipyretic medicines, inhibit these prostaglandins, thereby inhibiting the natural immune response. By reducing the fever, they can mask sinister symptoms and prolong an infection

Reserve these drugs for pain and discomfort associated with illness. They don't prevent febrile convulsions, and there is NO evidence that they improve the illness. 

Just Stop treating fever!!! Fever is your friend!

Share this with your parents, colleagues and anyone you know sucked in by advertising that tries to sell a message that "Brand N" or "Brand P" is for pain and fever. 

FEVER IS YOUR FRIEND!!

This 2011 article is just another paediatric journal that refreshes the notion that antipyretics are to be reserved for discomfort.

http://pediatrics.aappublications.org/content/pediatrics/127/3/580.full.pdf

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