National News

If Fever Helps Fight Infection, Should I Avoid Fever-Reducing Drugs?

Posted May 14, 2018 4:08 p.m. EDT

Q: If fever is the body’s way of fighting infection, should I avoid anti-fever medicines such as acetaminophen and ibuprofen?

A: The best evidence suggests that there is neither harm nor benefit to treating a fever with fever-reducing medications like acetaminophen or ibuprofen.

Hundreds of millions of years ago, animals developed fever as an evolutionary response to infection. Awareness of this phenomenon has given rise to two appealing, but conflicting, schools of thought. One is that fever is a natural response to infection, so one shouldn’t interfere with it; the other is that fever is a potentially harmful consequence of infection, so one should suppress it to minimize its complications.

In the pre-antibiotic era of the early 20th century, doctors prescribed pyrotherapy, a medically induced fever, as a treatment for a variety of conditions from syphilis to rheumatic fever. They used various methods to raise the patient’s body temperature to between 103 and 107 degrees Fahrenheit. But whether such treatments were beneficial is anybody’s guess, as the studies were conducted before the modern era of statistical methodology. Perhaps the most telling commentary on the value of pyrotherapy is the rapidity with which it was abandoned following the introduction of penicillin.

Nevertheless, advocates of the benefits of fever continue to point to encouraging results from small experimental studies, which suggest that fever might improve immune function, kill bacteria and help antibiotics to work better. Proponents also argue that there is little evidence that fever itself, even a high one, is harmful.

In 1997, these data led to a large, randomized, placebo-controlled trial of ibuprofen in 455 patients with sepsis, a life-threatening infectious condition. In this study, ibuprofen failed to prevent the worsening of sepsis and failed to decrease the risk of death.

In 2015, the largest study to date was published. Investigators in Australia and New Zealand performed a randomized, placebo-controlled trial of acetaminophen in 700 critically ill patients with fever. They found no difference in the number of days that patients required intensive care, and no difference in their odds of death after 90 days.

So it is probably safe for you to defer taking anti-fever medicines for minor illnesses. On the other hand, since rigorous clinical trials have shown that these drugs do not worsen outcomes, why not make yourself comfortable?