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Pharmacist Guide to Managing Fever


Pharmacist's Guide to Managing Fever

 

 

Pharmacist’s Guide to Managing Fever: A Systematic Approach to Patient Evaluation and Counseling

 

What is fever?

  • A fever is defined as having a body temperature greater than the normal core temperature of 100°F (37.8°C).
  • Normal body temperature can fluctuate and average between 97.5°F (36.4°C) and 98.9°F (37.2°C).
  • Fever is a very prevalent symptom that is often recognized as one of the chief causes of visits to the emergency department or pediatrician for patients younger than 15.
  • Although most fevers can be easily managed with proper treatment, the presence of a fever may also indicate a serious underlying illness, such as an acute infection that requires immediate evaluation and treatment.

Causes of Fever

A fever may be classified as idiopathic in nature, but it can also be the result of numerous factors, such as an infectious or pathologic process, a vigorous exercise, or a response to the use of certain pharmacological agents, also known as a drug fever.

Examples of drugs associated with drug fever include

  • certain anti-infectives (macrolides, penicillin, and tetracyclines).
  • antineoplastics (bleomycin, daunorubicin, and hydroxyurea).
  • cardiovascular agents (methyldopa, nifedipine, and quinidine).
  • and central nervous system agents (lithium; serotonin and norepinephrine reuptake inhibitors; selective serotonin reuptake inhibitors; and tricyclic antidepressants)
  • In general, most fevers are caused by microbial infections, including bacterial, fungal, and yeast infections.
  • Fevers may also transpire after the administration of common childhood immunizations.
  • Patients with fevers may also experience other signs and symptoms that can cause discomfort, such as arthralgia, chills, flushed face, a general feeling of malaise, headache, myalgia, and sweating
  • The occurrence of a fever is often a cause for concern for many patients and particularly for parents/caregivers of pediatric patients younger than 5.
  • Pharmacists can assist patients and caregivers by educating them about the best measures to manage and treat fevers, including the proper use of nonprescription antipyretics.

Detecting Fevers

  • During counseling, patients should be advised to avoid feeling the forehead to check for a fever and instead use a reliable thermometer to obtain an accurate reading.
  • Patients should also be advised to adhere to the manufacturer’s recommended procedures. Digital thermometers are the most extensively used measuring devices and are offered with an assortment of features that allow temperatures to be measured via axillary, oral, rectal, temporal, or tympanic routes.
  • During an illness, the temperature should be measured with the same thermometer at the same site because readings from different thermometers or sites can vary.

Pharmacist Guide to Managing Fever

  • The use of a rectal thermometer is the preferred method for temperature measurement in patients up to 3 months of age.
  • The use of a tympanic thermometer is not recommended for those younger than 6 months of age because of the shape and size of the infant’s ear.
  • Although measuring temperature rectally is preferred for those patients 6 months to 3 years of age, oral, tympanic, and temporal temperature measurement may be used in this patient age group if proper technique is used.
  • In those patients older than 3, oral, temporal, and tympanic temperature measurement can be used.

Treating Fever

  • The main goal in the self-treatment of fever is to relieve the discomfort commonly associated with fevers by reducing temperature to normal body temperature.
  • However, it is important to also identify and treat the underlying cause of the fever.
  • Nonprescription antipyretics and nonpharmacological measures are often used in the management and treatment of fever.

Nonprescription antipyretics include

  • acetaminophen (APAP)
  • and nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen, and naproxen.
  • APAP and ibuprofen are the 2 most extensively used antipyretics.
  • Ibuprofen is approved only in patients 6 months and older for fever reduction.
  • Antipyretics are available in a variety of formulations for adults and children as single-entity or combination products in capsules, chewable tablets, enteric-coated forms, extended- or sustained-release forms, gel capsules, liquid gels, liquids, rapid-release gel capsules, suspensions, and tablets.
  • Acetaminophen is also available in suppository form for pediatric patients. Classically, the reduction of temperature and the alleviation of discomfort occur about 30 to 60 minutes after administration of antipyretics.
  • Nonpharmacological measures, such as drinking fluids to prevent dehydration, maintaining a comfortable room temperature, and wearing lightweight clothing, should also be incorporated into treatment.
  • During counseling, pharmacists should confirm that caregivers and patients understand how to properly use antipyretic products, including dosing, administration, and possible adverse effects.
  • Parents and caregivers should also be reminded to give children only those products that are formulated for children and to use appropriate measuring devices that accompany these products.
  • Pharmacists should also screen for potential drug interactions and contraindications. Because antipyretics can also be found in many allergy, cold, cough, and flu products, patients should be advised to always read all medication labels prior to administration to avoid therapeutic duplications or possible medication overdose.
  • Moreover, if patients and caregivers are unsure about correct dosing, especially for children, they should always contact their primary health care provider to avoid potential dosing errors.

Pharmacist Guide to Managing Fever

When to contact a primary health care provider?

Caregivers and patients should be directed to always contact their primary health care provider immediately regarding fever if they have any concerns, especially if any of the following apply because they are examples of exclusions for self-treatment.

  • A child 3 months or older has a rectal temperature of 104°F (40°C) or higher.
  • A child younger than 3 months old has a rectal temperature of greater than 100.1°F (38°C).
  • A child 2 years or younger has a fever that lasts longer than 24 to 48 hours.
  • The patient has a rash.
  • The patient is exhibiting signs of infection.
  • The patient refuses to drink any fluids and shows signs of dehydration, such as decreased urinary output and dry mouth.
  • The patient is extremely irritable, sleepy, and weak.
  • The patient shows signs of infection, such as severe ear pain or a sore throat.
  • The patient has a stiff neck or is vomiting.
  • The patient has a history of febrile or other kinds of seizures.
  • The patient has diarrhea or a headache or is in extreme discomfort.
  • The patient has immune system problems or other chronic medical conditions.

Pharmacist’s Role in Managing Fever

As a pharmacist, when approaching a fever patient, it is important to follow a systematic thinking approach to ensure proper evaluation and management.

Here is a stepwise breakdown of the process:

Step 1: Gather Patient History

  • Start by obtaining a detailed medical history from the patient. Ask questions about the onset and duration of fever, associated symptoms like cough, sore throat, headache, and any recent travel, exposure to sick individuals, or immunization history. Also, inquire about any medications or allergies the patient may have.

Step 2: Conduct a Physical Examination

  • Perform a thorough physical examination to look for signs of infection or other underlying causes of fever. Assess the vital signs such as temperature, heart rate, respiratory rate, and blood pressure. Examine the skin, throat, ears, chest, abdomen, and any other areas that may provide clues to the cause of the fever.

Step 3: Assess for Red Flags

  • Identify any “red flags” or warning signs that may indicate a serious underlying condition. These can include severe headache, neck stiffness, altered mental status, difficulty breathing, abdominal pain, rash, or any other concerning symptoms. Red flags may warrant immediate referral to a healthcare professional or emergency department.

Step 4: Determine the Cause

  • Based on the history and physical examination findings, try to determine the most likely cause of the fever. Common infectious causes include respiratory tract infections (e.g., common cold, flu), urinary tract infections, skin infections, and gastrointestinal infections. Non-infectious causes such as drug reactions, autoimmune diseases, and malignancies should also be considered.

Step 5: Order Appropriate Diagnostic Tests

  • If needed, order diagnostic tests to confirm or rule out potential causes. These may include blood tests (complete blood count, blood cultures, etc.), urine analysis and culture, throat swabs, imaging studies (chest X-ray, ultrasound, etc.), or other specific tests based on the suspected cause.

Step 6: Provide Symptomatic Relief

  • While awaiting test results or definitive treatment, provide symptomatic relief to the patient. This may include recommendations for rest, plenty of fluids, over-the-counter fever reducers like acetaminophen or ibuprofen, and other supportive measures such as tepid sponging or wearing light clothing.

Step 7: Review Laboratory Results

  • Once the test results are available, review and interpret them carefully. Look for any abnormalities that may guide the diagnosis and further management.

Step 8: Determine Treatment Plan

What is the difference between the common cold and flu? And how to treat each of them with OTC medicine?

  • The common cold and the flu, or influenza, are both respiratory illnesses, but they are caused by different viruses and have distinct characteristics. Here are the key differences between the common cold and flu:

Pharmacist Guide to Managing Fever

Treating the common cold with over-the-counter (OTC) medications

Treating the common cold with over-the-counter (OTC) medications can help relieve its symptoms. Here are some steps to follow:

  1. Identify the symptoms: Common cold symptoms include a runny or stuffy nose, sore throat, cough, sneezing, mild headache, and sometimes a low-grade fever. Determine which symptoms you are experiencing.
  2. Choose the right medication: Look for OTC medications specifically designed to target your symptoms. Common options include decongestants, cough suppressants, expectorants, antihistamines, and pain relievers. Read the labels carefully and select the appropriate medication for your symptoms.
  3. Decongestants: If you have a stuffy nose, consider using a nasal decongestant spray or oral decongestant pills. These can help relieve nasal congestion and improve breathing. However, avoid using nasal sprays for more than a few days to prevent rebound congestion.
  4. Cough suppressants: Cough suppressants can be helpful if you have a persistent cough that interrupts your sleep or daily activities. They work by suppressing the cough reflex. Look for medications containing dextromethorphan.
  5. Expectorants: If you have a productive cough with mucus, an expectorant can help thin the mucus, making it easier to cough up. Look for medications that contain guaifenesin.
  6. Antihistamines: Antihistamines can alleviate sneezing, runny nose, and itchy or watery eyes. They can also have a sedating effect, so choose a non-drowsy option if you need to stay alert during the day.
  7. Pain relievers and fever reducers: Over-the-counter pain relievers like acetaminophen or ibuprofen can help reduce fever, headache, body aches, and sore throat. Follow the recommended dosage and avoid exceeding the daily limit.

Pharmacist Guide to Managing Fever

  1. Follow the instructions: Read and follow the instructions on the packaging carefully. Pay attention to the dosage, frequency, and any warnings or interactions.
  2. Stay hydrated: Drink plenty of fluids to stay hydrated and help thin mucus. Warm fluids like tea or soup can also provide soothing relief for a sore throat.
  3. Rest and take care of yourself: Get plenty of rest to support your immune system and aid in recovery. Use a humidifier to add moisture to the air, which can help with nasal congestion and throat irritation.

It’s important to read and follow the instructions on each medication carefully. If symptoms persist or worsen, it’s advisable to consult a healthcare professional for further evaluation and guidance.

Treatment of flu with over-the-counter (OTC) medicine

The treatment of flu with over-the-counter (OTC) medicine typically focuses on relieving the symptoms and providing comfort.

Here are some common OTC medications that can be used for flu treatment:

  1. Pain and Fever Reducers: Medications like acetaminophen (Tylenol) or ibuprofen can help reduce fever, headache, and muscle aches commonly associated with the flu. Always follow the recommended dosage on the packaging and consult a healthcare professional if you have any concerns.
  2. Decongestants: Nasal decongestant sprays or oral decongestant tablets can temporarily relieve congestion and stuffiness in the nasal passages. Be mindful of using decongestant sprays for more than three consecutive days, as they can cause rebound congestion.
  3. Cough Suppressants: Over-the-counter cough syrups or cough drops containing ingredients like dextromethorphan can help alleviate cough symptoms. However, remember that coughing also helps to clear the airways, so cough suppressants should only be used if the cough is disruptive or interfering with sleep.
  4. Expectorants: OTC expectorants, such as guaifenesin, can help loosen and thin mucus, making it easier to clear from the airways. This can be helpful if you have a productive cough with thick mucus.
  5. Throat Lozenges or Sprays: Sore throat is a common symptom of the flu, and lozenges or throat sprays containing ingredients like benzocaine or menthol can help provide temporary relief by numbing the throat.

It is essential to read and follow the instructions on the packaging when using any OTC medication. If symptoms persist or worsen, it is advisable to consult a healthcare professional for further evaluation and guidance.

Conclusion

  • A fever is defined as having a body temperature greater than the normal core temperature.
  • Although most fevers can be easily managed with proper treatment, the presence of a fever may also indicate a serious underlying illness, such as an acute infection that requires immediate evaluation and treatment.

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