Fever

The Secret of Great Health Care

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Fever

Extra: How to Manage a Fever with Medications

Understanding Fever

Fever

A fever is an increase in body temperature. Normal body temperature is often quoted as 98.6 degrees Fahrenheit, but a range of temperatures between 97 and 99 degrees Fahrenheit may be considered normal. Many people's body temperature will even fluctuate throughout the day, with fever being higher at night and lower in the morning.

A fever is an adaptation that the body makes in response to some sort of stressor such as an infection or another illness. The increased body temperature may be the body’s way of trying to fight the stress.

Many times a parent or health care provider can tell if there is a fever by just touching the skin, but ideally the degree of fever should be quantified.

Temperature above 99.5 degrees Fahrenheit when taken orally or 100.4 when taken rectally is a fever. The severity of the fever needs to take into account the age of the individual, the degree of fever, and what other symptoms they are having.

The individual needs to see the doctor if any of the conditions listed under "who needs to see a doctor" is present. Children less than 3 months old with a fever need to see a doctor. Kids between 3 months and 3 years old should see a doctor if the temperature is greater than 102 degrees Fahrenheit.

Severe illness with a fever is often indicated when: someone is not eating or drinking, doesn't want to play or do regular activities, is drowsy, is pale and clammy. Individuals who are not as sick will look much better when the fever dissipates.

What is the cause of fever

Many things can cause a fever.

An infection is the most common cause

Other illnesses such as cancer or autoimmune diseases (Lupus or rheumatoid arthritis)

Overdressing – more common in very young children

Immunizations

Who needs to see a doctor
Red flags are situations that require urgent and sometimes emergent medical care. Red flags for fever vary depending on age. The list is long, but most red flags are not common. Anyone with the following complaints should see a doctor.

Stiff neck

Abdominal pain

Persistent vomiting

Extreme sleepiness

Excessive crying or fussiness in a child

Severe headache

Sensitivity to bright light

Shortness of breath

Chest pain

Difficulty swallowing/drooling/severe sore throat

Severe heart or lung disease such as severe emphysema or heart failure (usually in adults).

Confusion

Immune system dysfunction (for example, those with cancer or AIDS)

Anyone with head trauma

Newborns who have a temperature less than 97 degrees Fahrenheit

A child with a purple rash

Children with a history of febrile seizures

Risk for hyperthermia (someone who has participated in extreme exercise or who has been left in a hot environment such as a car)

Any fever over 105 degrees Fahrenheit, fever above 106 degrees Fahrenheit often occurs with bleeding into the brain

Anyone under 6 months-old who has a rectal temperature equal to or greater than 100.4 degrees Fahrenheit

Anyone under 2 years-old who has a rectal temperature greater than or equal to 102 degrees Fahrenheit

An adult or older child with a persistent fever above 103 degrees Fahrenheit

Fever that persists beyond five days

Individuals who cannot describe the symptoms need evaluation (young child or older adult with confusion)

How to treat a fever

What to do?

If you suspect a fever, you should quantify the fever by measuring the body temperature. Thermometers can be bought on line at CWI Medical – Medical Supplies and Health Care Products.

Are there any red flags? If yes, contact your health care provider.

Take inventory of your symptoms to help determine the possible cause of your fever (see fever worksheet at the end of the chapter). Refer to other sections on those other symptoms.

Not every fever needs to be treated. The fever is there for a reason and may be helping the body fight the cause of the fever

If temperature is above 102 degrees Fahrenheit or the individual is uncomfortable use drug and non-drug methods to reduce fever.

Over-the-counter products

Any fever that creeps above 102 degrees Fahrenheit should probably be treated. The three most common medications used in the treatment of fever are:

Aspirin

Acetaminophen

Non-Steroidal Anti-Inflammatory Medications (NSAIDS)

Aspirin is a pain reliever as well as a medication that will help bring down fever. It may upset the digestive tract in some people and has been linked to ulcers. One advantage is that it is inexpensive. Aspirin is not recommended in those who are under 18 as there is a risk of a rare neurological disease called Reye's syndrome.

While children should not use aspirin or naproxen sodium (Aleve) they can use both acetaminophen and ibuprofen. The dose of acetaminophen and ibuprofen is based on weight – see the table: Pain Medication/Fever Reducers: Dosages in Children.

Acetaminophen, known under the brand name Tylenol, is a common medication to treat both pain and fever. When used for short periods of time it is a very safe drug. It lacks major drug interactions.

One draw back with this medication is that it lacks anti-inflammatory effects. This means that when there is inflammation, which often contributes to certain types of pain, acetaminophen may not the best option.

It is toxic in high doses and should be minimized to less than 4 grams a day in the adult. If you follow the labeling on the bottle, you will not overdose. In overdose, acetaminophen has its toxic effect on the liver. Combining acetaminophen and alcohol is not recommended.

Acetaminophen will provide relieve for 4-8 hours depending on which formulation is taken.

Non-Steroidal Anti-inflammatory (NSAIDs) medications are another group of medications that are commonly used in the treatment of pain and fever. Like acetaminophen, it is safe when used for a short period of time.
NSAIDs have more side effects and needs to be used cautiously in certain groups of people, especially when used for extended periods of time. People at risk included those with kidney disease, heart disease, heart failure, high blood pressure and stomach ulcers.

NSAIDs have more side effects than other pain medications. They should not be used in combination with alcohol. In addition, their regular use may interact (see table) with some blood pressure medications (the table that leads to the link provides information about interactions of many commonly used drugs).

Naproxen sodium is another pain/fever reducer that is classified as a NSAID. It is not indicated for the child less than 12 years old and has similar side effects as ibuprofen.

It is critical to keep pain relievers/fever reducers available at home. To purchase products discussed in this chapter visit The Drug Store.

Summary

Try to determine what is causing the fever
Not all fever needs to be treated
Fever above 102 degrees Fahrenheit or in a patient who is uncomfortable or in pain should be treated
Three classes of medications are useful in the treatment of fever: Aspirin, acetaminophen and NSAIDs
Acetaminophen and ibuprofen are the recommended fever reducers in children.

Pain Relievers/Fever Reducers

	Brand names	Dose	Side effects	Notes
Acetaminophen
Acetaminophen	Tylenol	325 mg – 12 and older take 2 pills every 4-6 hours, children 6-11-years-old take 1 tablet every 4-6 hours	Few when used as directed for a short period of time	Overdose will affect the liver, do not use with alcohol; Is not an anti-inflammatory drug
Acetaminophen extra strength	Extra strength Tylenol	500 mg – 12 and older take 2 pills every 6 hours
Liquid acetaminophen	Liquid Tylenol	see package for dosing
Ibuprofen
Ibuprofen	Motrin	200-400 mg every 6-8 hours as needed	Stomach bleeding, upset stomach, abdominal bloating	Do not use during the last 3 months of pregnancy; Use caution in those with bleeding problems, on a blood thinner, those with asthma, a stomach ulcer, high blood pressure, heart or kidney problems or those over 60 years-old
	Advil	200-400 mg every 6-8 hours as needed
Liquid ibuprofen		see package for dosing
Naproxen sodium
Naproxen sodium	Aleve	12-years-old and older – take one tablet (220 mg) every 8-12 hours, 2 pills may be taken for the first dose	Stomach bleeding, upset stomach, abdominal bloating, high blood pressure	Do not use during the last 3 months of pregnancy; Use caution in those with bleeding problems, on a blood thinner, those with asthma, a stomach ulcer, high blood pressure, heart or kidney problems or those over 60 years-old
Aspirin
Aspirin	Bayer/Ecotrin/St. Joseph	Take as directed on the label	Stomach bleeding, upset stomach, abdominal bloating	Do not use in children especially those with the flu, chickenpox or another viral illness

Pain Medication/Fever Reducers: Dosages in Children

	Children Dosing
Drug	Weight in pounds	Single dose (in mg)
Acetaminophen	6 to 11	ask doctor
10-15 mg/kg	12 to 17	ask doctor
	18 to 23	ask doctor
	24 to 35	160
	36 to 47	240
	48 to 59	320
	60 to 71	400
	72 to 95	480
	96 and over	see adult dose

Ibuprofen	6 to 11	ask doctor
7.5 mg/kg	12 to 17	62.5
	18 to 23	75
	24 to 35	100
	36 to 47	150
	48 to 59	200
	60 to 71	250
	72 to 95	300
	96 and over	see adult dose

Drug interactions

Drug A	Drug B	What could happen	Notes
Antacid	Quinolone antibiotic, tetracycline	Decreased absorption of the antibiotic	Give antibiotic 2 hours before or 6 hours after the antacid
Warfarin	Antibiotic	Decreased or increased warfarin level	Doctor should watch INR (warfarin level)
Warfarin	NSAID, ASA	Bleeding	Avoid use together
Warfarin	Tylenol	Bleeding	Risk is not as great as NSAID, minimal risk with one or two doses but ideally should be avoided
Clarithromycin (Biaxin)	Statins	Increased statin level/muscle damage	Consider other antibiotics
Quinolones	Prednisone	Tendon Rupture	Avoid use together, especially in older adults. Patient should watch for any muscle pain, swelling, or rupture of a tendon.
Antidepressants (SSRIs)	NSAID	Increased risk of bleeding	Pt should watch for any increase in bleeding. APAP is a safer option for pain/fever control
Theophylline	Antibiotics	Increased levels of Theophylline	Theophylline levels should be watched
ASA	Some anti-seizure medications	ASA may increase the amount of seizure medication in the blood	Levels of anti-seizure medication may need to be monitored and any signs or symptoms of toxicity need to be watched for
NSAIDs	Blood pressure medications called beta blockers (propranolol, metoprolol, atenolol)	NSAIDs may decrease the ability of the blood pressure medications to lower the blood pressure	Blood pressure needs to be monitored or medications adjusted
Antihistamines	Sedatives, anti-anxiety medications, sleeping pills and muscle relaxants	May increase sedation	Avoid use together
Pseudoephedrine (Sudafed)	Blood pressure medications	Reduced effect of the high blood pressure medications	Other methods to decongest the nose should be sought
Dextromethorphan (Robitussin DM)	Sedatives	Increased sedation	If used together monitor for sedation
Antacid – Tums, Rolaids; NSAID – Non steroidal Anti-inflammatory drugs (ibuprofen, naproxen); ASA – Aspirin; Quinolone antibiotics (Ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox)	SSRI – Selective Serotonin Reuptake Inhibitors [antidepressants – sertraline (Zolft), citalopram (Celexa), fluoxetine (Prozac)]; Statins – cholesterol lowering drugs (simvastatin (Zocor), atorvastatin (Lipitor)	Sedatives – some anxiety medications and sleeping pills