A5V4d

9 Antipyretic
interventions
Introduction
Fever is an increase in temperature that occurs as the result of the action of substances known as
pyrogens upon the hypothalamus, the part of the brain that controls body temperature. These
pyrogens have the effect of increasing the temperature set-point of the hypothalamus, which causes it
to increase the temperature of the body. 205 The hypothalamus is sometimes likened to a thermostat,
instigating heat promotion or loss procedures to achieve the desired set-point temperature. It is
important to differentiate fever, which is regulated by the body, from hyperthermia, which is caused by
external factors and is not regulated by the hypothalamus.
Fever is a normal physiological response to infection and a number of other conditions. Although it is
a normal response, some people, including many doctors, nurses and parents, believe that fever
should be treated to reduce temperature. This is usually either because of concerns about the
damaging effect of fever or because it is thought to be a distressing symptom. 205,206 However,
opinions differ about this, with others believing that fever should be allowed to run its course. 207
If it is thought necessary to reduce fever, there are a number of interventions that are or have been
used, either alone or in combination. Pharmacological treatments differ fundamentally from physical
treatments, as they aim to lower the hypothalamic set-point rather than simply cool the body. If it is
thought necessary to reduce fever, the safest, most clinically and cost-effective treatments and those
most acceptable to the child should be used. The first question that the guideline development group
(GDG) considered was what, if any, antipyretic interventions should be used. A variety of
interventions were considered, specifically drugs, such as paracetamol and ibuprofen, and physical
methods such as tepid sponging.
9.1 Effects of body temperature reduction
Antipyretics in the prevention of febrile convulsions
In addition to the underlying illness, fever may be accompanied by a number of unpleasant symptoms
including pain, reduced eating and drinking, and reduced activity. In some cases, for example pain,
this is likely to be the result of the illness causing the fever or the immune response to it. However, in
other cases it is not always clear whether these are the direct result of the fever, or of the underlying
illness, or a combination of the two. The GDG therefore considered the use of antipyretic interventions
in the treatment of these symptoms. However, it is difficult to know what symptoms to measure and
how to do so reliably.
A particular concern of many parents about fever in children is that it may cause fits, or febrile
convulsions. 206 These are common in young children, and are very rarely associated with epilepsy or
other problems in later life. 230 Because antipyretics reduce temperature, there is a theoretical rationale
for their use in the prevention of febrile convulsions.
Review question
Does the use of antipyretic interventions in children with fever serve a benefit or harm in terms of any
of the following:
time to recovery
wellbeing
192