Physicians have used various forms of antipyretic therapy since
antiquity to lower the temperature of febrile patients. Nevertheless,
it has yet to be determined whether the benefits of antipyretic
therapy outweigh its risks. It is not known, for example, if
core temperatures encountered during the febrile state ever
reach levels that are intrinsically noxious (and therefore merit
antipyretic intervention) or when, if ever, fever's metabolic
costs exceed its physiologic benefits, or if the benefits of
symptomatic relief afforded by antipyretic drugs consistently
exceed their toxicologic cost. Whereas preliminary experimental
and clinical observations suggest that antipyretic therapy has
the potential to increase the duration and/or severity of certain
infections, such data are as yet too fragmentary to draw firm
conclusions regarding their validity. Finally, although clinicians
have long suspected that bacteremia and other severe infections
might induce fevers that are less responsive to antipyretic
therapy than are those associated with self-limited infections,
this concept has not held up under scientific scrutiny. Thus,
despite over 2.5 millennia of clinical experience, important
questions regarding the risks and benefits of antipyretic therapy
remain to be answered.
