Summary of main points from an analysis of current evidence by the Oxford EBM group.
The current evidence does not support routine antipyretic administration to treat fever in acute respiratory infections and COVID-19.
Many protocols and professionals advise patients to self-medicate for Covid-19 using antipyretics. Panic buying has led to temporary shortages in some areas.
Benefits of a Fever
- Fever is a physiological and adaptive response to infection.
- Fever is common and is a good prognostic sign in acutely unwell patients with infection, associated with higher rates of survival.
- In a prospective observational study (n= 502) fever inhibited microbial reproduction and viral replication, and accelerated the rate of phagocytosis.
- Heat-shock proteins (present in fever) are also thought to prevent thermal damage to cells by inhibiting pro-inflammatory-signalling pathways.
- An individual’s ability to mount a febrile response has been shown to be a good prognostic sign in critically unwell patients (Lee 2012, Young 2012),
Are there indications for taking an antipyretic in Covid-19?
Adults: For most adults, there is no convincing evidence that fever is itself detrimental and does not automatically require suppression.
- Some advocate avoidance of antipyretics in infections, extrapolating from studies of acetaminophen after vaccination, showing reduced antibody response to some antigens (Prymula 2009).
- RCTS have shown no evidence that antipyretics reduce the incidence of seizures in susceptible children (Offringa and Newton 2013).
- A systematic review on the prolongation of febrile illness with the use of antipyretics in children who have acute infections suggested antipyretics do not slow recovery from infectious diseases. (Williams 2014)
Pregnancy: is not specifically covered in this document.
Elderly, or patients with comorbidities: May be more vulnerable to increased physiological demands during fever however they also have less of a febrile response and frequently have contraindications to NSAID use. (Carey 2010, Launey 2011)
If symptom relief is required, acetominophen is preferred over NSAIDs: see COVID And NSAID Use: Where’s The Harm?
Prepared by Dee Mangin, March 31, 2020