USES AND ABUSES OF ANTIPYRETIC THERAPY

Abstract

FEVER is undoubtedly the most common symptom confronting the physician who treats children. It is fought as though it were the patient's primary disease, and its mere presence is often accepted as being sufficient indication for the institution of antipyretic therapy. It is not surprising, therefore, that therapeutists and pharmaceutical concerns have energetically sought new and better drugs for the control of fever. In the past few years there has appeared on the market a number of new formulations which are purported to offer distinct advantages in terms of antipyretic potency, acceptance by children, and/or reduced toxicity.

It is axiomatic that virtually any claim regarding a drug can be supported by published data, if the proper study is selected and interpretation is sufficiently influenced by conviction. Particularly is this true of antipyretic-analgesic drugs, where such factors as lability in the case of fever and lack of objectivity in the case of pain, make evaluation difficult. The claims and counterclaims which have been made concerning antipyretic drugs have led to considerable confusion and misunderstanding on the part of clinicians in general. The purpose of this presentation is to attempt to provide some clarification of this problem.

IS ANTIPYRESIS INDICATED?

More critical than the choice of an antipyretic is the question of whether or not such therapy is indicated in the individual case, for there is little doubt that these drugs are grossly overused, at times to the detriment of the patient. Therefore, before discussing the antipyretics themselves, it seems appropriate to review briefly a number of points which deserve consideration before one elects to use an antipyretic.

DuBois summarized a lifetime of study on fever and the regulation of body temperature with the statement: "Fever is only a symptom and we are not sure that it is an enemy. Perhaps it is a friend." The literature concerning the possible role of fever in body defenses is extensive and inconclusive.