Pathophysiologic Basis for Symptomatic Treatment of Fever

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Abstract
Fever is one of the most obvious clues which allow one person to determine that another is sick. In pediatrics, it accounts for many telephone calls and upwards of 30% of all visits.1,2 Fever was long thought to require treatment as a disease in its own right. Sanctorius3 introduced the thermometer into clinical medicine shortly after its invention by Galileo4 early in the 17th century. Almost 200 years later, Wunderlich began his classic studies on medical thermometry.5 This ended fever's masquerade as a disease and relegated it to its proper role as a sign. The patient's anxiety and demand for treatment and the physician's desire to render antipyretic therapy have not been greatly affected by our rapidly increasing understanding of the regulation of central body temperature and the pathogenesis of fever. In fact, our present information already suggests that some common therapy directed at this symptom is unnecessarily uncomfortable, ineffective, or even dangerous. Nowhere in medical education is there greater disparity between the frequency of a clinical problem and the amount of formal teaching devoted to its pathophysiology and management. The major pediatric texts6,7 scarcely take any note of the symptom, fever, at all and offer virtually no information on its treatment. Rational treatment requires an understanding of temperature regulation, heat production and conservation, an appreciation of the pathophysiology of different febrile states, and knowledge of the mechanisms by which various therapeutic measures lower body temperature. Finally, some thought should be given to the possibility that fever is in some way a useful defense mechanism and should not be treated at all.

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