Approach to fever (pyrexia) management

Definition

Fever (pyrexia) is an abnormal elevation of body temperature that occurs as part of a specific biological response mediated and controlled by the central nervous system. It is usually a symptom of an underlying infection and is characterized by a body temperature above the normal range of 36.5–37.5°C.

Clinical presentation

Patients with fever may present with:

• Depression

• Lethargy

• Anorexia

• Sleepiness

• Hyperalgesia

• Inability to concentrate

• Feeling cold

• Increased muscle tone

• Shivering

• Irritability

Investigations

Investigations should be guided by the patient's clinical presentation.

Recommended investigations include:

• Rapid malaria test

• Blood slide for malaria parasites

• Point-of-care urine dipstick

• Point-of-care ECG

• Bedside ultrasound (gallbladder, liver, spleen, abdominal aorta, kidneys, and other relevant structures)

• Serum electrolytes

• Serum creatinine and urea

• Complete blood count

• Serum lactate

• Radiological investigations:

  • X-ray

  • CT scan, where indicated

Non-pharmacological treatment

• Perform both primary and secondary assessment and provide appropriate interventions when indicated.

• Advise the patient to rest.

• Encourage adequate oral fluid intake if the patient is able to drink.

Notes

• In children, a temperature >40°C requires urgent reduction.

• Lukewarm sponging and evaporative cooling are not recommended.

• Fever caused by viral infections is usually self-limiting; however, all other causes of fever require appropriate treatment.

Pharmacological treatment

Administer antipyretic medication as needed.

Oral antipyretics

Use one of the following:

Paracetamol (PO)

• Adults: 1 g every 6 hours when required.

• Children: 15 mg/kg every 6 hours when required.

• Rectal suppository: 125–250 mg every 6 hours, where appropriate.

OR

Ibuprofen (PO)

• Adults: 400 mg every 8 hours when required.

• Children: 5–10 mg/kg every 8 hours when required.

Patients unable to take oral medication

Paracetamol (IV)

• 1 g.

Referral

Refer the patient to a higher-level facility with appropriate expertise and resources if:

• No diagnosis can be established.

• Fever does not improve after antibiotic therapy.

• Fever recurs.