November 16, 2022
Updates and focus, Special Paracetamol
Fever is a controlled phenomenon, which represents the increase in body temperature, due to the change of the threshold value at the level of the hypothalamus. (1) A different phenomenon, much more worrying, is hyperthermia, which consists in the uncontrolled increase in temperature, while the hypothalamic threshold value remains unchanged. (1)
Fever may therefore represent a physiological and systemic response to infection, known as the acute phase response. (1) During this stage, the body reacts to infection with a pathogen by introducing a variety of responses, including the onset of other uncomfortable symptoms, such as general malaise, low mood, lethargy, and ache. (1)
The onset of fever can be perceived as an alarming situation and a source of discomfort, just as the last stages, those in which the body temperature finally drops, are equally uncomfortable. (1)
Although fever is often considered a symptom to get rid of, it therefore represents an important mechanism that the body puts in place to defend itself from pathogens, as well documented by numerous in vivo and in vitro studies. (1) The basic mistake that is often made is to believe that fever is caused by the infection itself and not by the body trying to fight it. (1)
The elevation in temperature that occurs with fever stimulates the activation of a variety of immune cell functions, including motility, phagocytosis, and the production of reactive oxygen species by neutrophils and monocytes. Similarly, fever facilitates the function of dendritic cells, natural killer cells, T lymphocytes and also stimulating the production of antibodies. (1) Fever also stimulates the cellular response to substances such as type 1 interferon, a molecule with marked antiviral activity. (1)
An increase in body temperature, if on the one hand it supports the protective action of the immune system, on the other it hinders the activities of pathogenic organisms, increasing their vulnerability and thus further facilitating their elimination by the immune cells. (1)
In the presence of fever, therefore, it is important to carefully evaluate the risks and benefits of an action through antipyretic therapy. In fact, there are cases in which it is advisable to let the temperature rise and for the body to exploit this increase for its own defence, and situations in which it is instead advisable to act by reducing the accumulated heat, through the use of antipyretic products, precisely . (1)
The latter behavior is specifically valid in all those cases in which the patient is particularly tried by the discomfort deriving from fever (a fact which occurs with particular frequency when analyzing the pediatric population) or is affected by other conditions which debilitate the body, such as cardiovascular problems, or if you are pregnant. (1,2)
In the specific case of children, the recommendations of the Italian Society of Pediatrics (SIP) reaffirm the need to use antipyretics in the event of discomfort or the presence of other further debilitating pathologies, preferring oral administration over rectal administration. (2) The only antipyretics recommended in the pediatric population are paracetamol and ibuprofen. (2) Paracetamol, in particular, appears to be the most suitable pharmacological tool, thanks to its favorable safety profile and efficacy in reducing the sensation of discomfort, as well as being the only one indicated from birth. (2.3)
Bibliography
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Wrotek S, et al. Let fever do its job. The meaning of fever in the pandemic era. Evol Med Public Health. 2021; 9(1): 26-35.
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Chiappini E, et al. 2016 Update of the Italian Pediatric Society Guidelines for Management of Fever in Children. J Pediatr 2017 Jan;180:177-183.e1.
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Doria M, et al. Understanding discomfort for the appropriate treatment of fever. The pediatrician 2019;28(3):11-23
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