While understanding of the mechanisms of fever has progressed in recent years, much uncertainty remains as to whether
fever in itself (as distinct from its cause) is beneficial or harmful,
and what circumstances warrant antipyretic therapy. This review
was designed to identify studies providing information on the
effects of fever and of pharmacologic and physical therapy.
Fever or analogous behavioral thermal upregulation apparently
has positive effects on defense against infection in some animal
models. Retrospective studies in humans suggest that failure to
mount a febrile response is associated with poor outcome in
certain infections but do not establish a causal relationship.
Induction of fever apparently had therapeutic value in infections
such as syphilis before specific antimicrobials were developed.
Fever may have deleterious effects in the context of borderline
cardiovascular or neurologic function or pregnancy, but data in
most instances cannot separate effects of fever per se from that
of underlying disease. Antipyretic drugs are effective in diminishing fever, but they have significant side effects and may suppress signs of ongoing infection. Physical cooling is important
when physiologic thermoregulatory mechanisms are overwhelmed, but may sometimes increase discomfort and metabolic stress in fever. Antipyretic therapy should not be instituted
routinely for every febrile episode but should be based on evaluation of relative risks in the individual case and reassessed if
anticipated benefits are not achieved.
(Arch Intern Med. 1990;150:1589-1597)