Management of Fever Above 38°C

First-Line Management of Fever Above 38°C

The American College of Physicians recommends oral antipyretics such as ibuprofen (0.2g per time, every 4-6 hours, maximum 4 times in 24 hours) as first-line treatment when temperature is higher than 38.5°C 1
Adequate oral hydration should be encouraged (up to 2 liters per day) to prevent dehydration in patients with fever 2
Maintaining temperature below 38°C is acceptable; much lower body temperature is not conducive to antiviral treatment in patients with fever 1

For persistent fever despite initial antipyretic therapy, consider adding a second antipyretic (e.g., adding an NSAID if paracetamol was used first) in patients who are not responding to initial treatment 2
IV fluids and IV antipyretics should be considered in patients with inability to tolerate oral intake 3
IV fluids and IV antipyretics should be considered in patients with signs of dehydration despite oral hydration attempts 1
The Society for Immunotherapy of Cancer recommends that fever during bone marrow recovery should be a diagnosis of exclusion; maintain high suspicion for infection in neutropenic patients 3
Avoid blind or inappropriate use of antibacterial drugs unless bacterial infection is suspected or confirmed in patients with fever 1