Updated: Jun 30
Knowledge, attitudes and misconceptions of primary care physicians regarding fever in children: a cross sectional study.
Ital J Pediatr. 2012 Sep 5;38:40. doi: 10.1186/1824-7288-38-40.
World J Clin Pediatr. 2012 Dec 8;1(4):29-33. doi: 10.5409/wjcp.v1.i4.29. eCollection 2012.
Fever management: Evidence vs current practice
"..The practice of alternating antipyretics has become widespread at home and on pediatric wards without supporting scientific evidence. There is still a significant contrast between the current concept and practice, and the scientific evidence..."
Acetaminophen decreases intracellular glutathione levels and modulates cytokine production in human alveolar macrophages and type II pneumocytes in vitro. Dimova S, et al. Int J Biochem Cell Biol. 2005. Authors Dimova S1, Hoet PH, Dinsdale D, Nemery B. Author information 1Laboratory of Pneumology, Unit of Toxicology, K.U. Leuven, Herestraat 49, B-3000 Leuven, Belgium. Citation Int J Biochem Cell Biol. 2005 Aug;37(8):1727-37. Epub 2005 Apr 26. J Family Med Prim Care. 2013 Apr;2(2):153-8. doi: 10.4103/2249-4863.117409. Comparison of cold water sponging and acetaminophen in control of Fever among children attending a tertiary hospital in South Nigeria http://www.ncbi.nlm.nih.gov/pubmed/24479070
Cochrane Database Syst Rev. 2002;(2):CD003676. Paracetamol for treating fever in children. Trial evidence that paracetamol has a superior antipyretic effect than placebo is inconclusive. There is limited evidence that there is no difference between the antipyretic effect of paracetamol and physical methods. http://www.ncbi.nlm.nih.gov/pubmed/12076499 . ======== Cochrane Database Syst Rev. 2003;(2):CD004264. Physical methods for treating fever in children. http://www.ncbi.nlm.nih.gov/pubmed/12804512 ==== When should I be worried? short video with the Paediatrician. -------- Good, balanced advice with humour, well done Doc! http://youtu.be/kUuBCy0lCJI ==== Tylenol lowers glutathione levels (Your body's most potent antioxidant) https://www.ncbi.nlm.nih.gov/pubmed/15878691. ==== Antipyretic therapy may increase the risk of mortality with viral infections https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2011/vol-124-no-1338/letter-eyers ==== Drugs R D. 2014 Jun; 14(2): 45–55. Published online 2014 Jun 12. doi: 10.1007/s40268-014-0052-x PMCID: PMC4070461 A Practical Approach to the Treatment of Low-Risk Childhood Fever http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4070461/ ==== Fever: Suppress it or let it Ride? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703655/ ==== Control of Fever in Septic Shock: Should We Care or Intervene? fever may be beneficial because fever increases clearance of microorganisms, immune response, and the heat shock response (6–8). Furthermore, control of fever can worsen outcomes (9, 10), whereas increasing temperature after endotoxemia can improve outcomes in animal models (11). In a retrospective cohort study, use of corticosteroids for fever control in H1N1-infected patients was associated with increased mortality (12). Finally, patients with septic shock who have hypothermia have a higher mortality than patients with fever (13). https://www.atsjournals.org/doi/full/10.1164/rccm.201202-0346ED?cookieSet=1
Fever is an important mechanism of intrinsic resistance against infectious disease.
A variety of studies point to a potential detrimental effect of temperature lowering in infectious disorders, but high-quality evidence from randomised controlled trials is lacking.
https://www.mja.com.au/journal/2011/195/8/fever-and-antipyresis-infection An increasing amount of evidence is now suggesting that fever lowering in infections, and particularly sepsis, may not be as harmless as previously thought. A number of studies that will be discussed here have shown that fever improves the immune response and leads to better outcomes in infections. https://www.escavo.com/2012/12/23/should-fever-reduced-septic-patients/