1. First, let’s understand what fever is all about.
Fever is one of the body’s self-protection mechanisms, a symptom that the body shows in the process of mobilizing the immune system to fight disease. The temperature of the body is often not proportional to the severity of the disease, and the sensitivity of thermoregulation will be different for individuals with different physiques. Some people can have a very high fever with a mild cold, while others do not necessarily have a high temperature even with a serious infection. In most cases, fever is caused by a cold, an ear infection or a lung infection. The “infection” in this case may be a viral infection or other pathogens such as bacteria.
The use of antipyretic drugs only relieves the symptoms of fever, but does not treat the infection itself, which is often called “treating the symptoms but not the root cause”, that is, the process of reducing fever does not mean the process of disease improvement. For example, if you have a common viral cold, it is normal to take fever-reducing medication and then have your temperature rise again in a few hours, and it is also common to have fever repeatedly for 3-5 days.
If the infection causing the fever is caused by a cold virus, the virus has a life cycle in the human body, generally about 5-7 days the body will produce the appropriate immunity to remove the virus on its own, no drugs to deal with the virus, and no special antiviral drugs can be used (except for influenza A, early influenza A can be used neuraminidase inhibitors).
If the infection causing the fever is caused by bacteria and other pathogens, it is necessary to choose antibiotics and other drugs under the guidance of a doctor to “treat the root cause”.
2.What are the methods of physical cooling?
Usually, a fever is defined as an axillary temperature over 37.2°C, an ear temperature over 37.8°C, an oral temperature over 37.5, and an anal temperature over 38.0°C. For the vast majority of babies over 3 months of age and adults, fever itself is not dangerous and does not burn the head or cause death.
Therefore, there is no need to use medication to treat fever in patients with axillary temperature below 38.5°C, if they show a good mental state and their activities such as playing, studying and working are not affected. You can try physical cooling first.
There are three methods of physical cooling.
One is to take a warm bath, through the way of bathing to achieve the purpose of whole body heat dissipation. When taking a bath, the recommended water temperature is 35℃ to 37℃. Also pay attention to adjust the temperature of the bathroom and other rooms, do not make too much difference between the two. If the temperature of other rooms is much lower than the temperature of the bathroom, after the bath, to dry and then out of the bathroom.
The second is to use a warm, wet towel to wipe the body. The temperature of the towel is best controlled at about 37 ℃. Use a warm wet towel to wipe the forehead, neck, armpits and extremities and other parts. Towel wipe body cooling principle is to let the skin vascular expansion, so that the heat generated in his body in time to dissipate out, and wipe the body with a warm wet towel, stained in the body of water evaporation, will also take away part of the heat.
The third is to wear less and cover less and wrap less.
In addition, remember to drink more water when you have a fever, the process of water excretion can accelerate the discharge of body heat. But be sure to drink a small number of times, do not drink too much at once, otherwise it will increase the burden on the kidneys.
People who have babies at home may share the feeling that it is too difficult to feed plain water to babies. Every family has different habits, and some babies are reluctant to drink plain water when they are exposed to things like sugar and honey too early, because people instinctively tend to taste things that taste good after being exposed to them. In order for babies to develop the habit of drinking plain water, try to avoid exposing them to sugar water and fruit juices too early.
When a baby has a fever, he or she will be weak, moody and have a poor appetite, and will not want to drink water even more. That’s when parents have to figure out what to do. For very young babies, parents can use a medicinal dropper, like feeding medicine to feed water, insert the dropper into the baby’s mouth, squeeze water into it, and feed a small amount several times, although parents work harder, but can ensure that the water is fed to the baby in a timely manner.
Encourage older babies to drink more water, you can play games with them while drinking water, or play the game of Cheers with him, or play the game of whoever drinks more with him wins. Babies are very receptive to your suggestions in a fun game.
We recommend the use of antipyretics to reduce fever in patients with axillary temperatures above 38.5°C. The main purpose is to relieve the discomfort caused by fever so that the patient can eat and sleep normally, get enough energy to fight the disease and maintain strength.
The safe and affordable fever reducers that are widely used worldwide and recommended by the World Health Organization are two oral medications: acetaminophen and ibuprofen.
1. Acetaminophen: the preferred fever reducer for children and adults over 3 months of age
The name of this drug is rather tongue-in-cheek, you may not be familiar with, but when it comes to paracetamol, Bilettone or Tylenol such drug names should not be unfamiliar, they are different names of the same drug, like the relationship between the name on a person’s ID card and the various nicknames of this person. They are both fever reducers that contain a single active ingredient, acetaminophen.
The dose of acetaminophen for children is 10-15 mg per kilogram of body weight, every 4 hours, up to 5 times a day.
For example, if your baby weighs 10 kg, the dose you can give each time is 100 mg-150 mg. If the concentration of acetaminophen you have is 100 mg per milliliter of drops, then 150 mg translates into a feeding volume of 1.5 ml. Any dose below this is safe, but should not be exceeded.
The usual recommended adult dose of acetaminophen is 500 mg or 650 mg every 4 to 6 hours, up to 4 times a day, with a maximum single dose of 1000 mg and a maximum dose of 4000 mg a day. Acetaminophen can be used by both pregnant and nursing women without harming the fetus or affecting the nursing baby.
Acetaminophen is safe to use at reasonable doses, but taking more than the maximum dose can cause liver damage. Ninety percent of the commonly used compound cold medicines contain acetaminophen, such as aminophen alkylamine granules, aminophen xanthamine granules, aminophen mamet syrup, phenol mametamine suspension for children, and day and night pepto-bismol, white plus black cold tablets for adults.
If you take single-ingredient acetaminophen to reduce fever while also taking the above-mentioned compound cold medicine, it is easy to overdose on acetaminophen due to repeated medication, so check the ingredients carefully before taking the medication and avoid stacking drugs containing the same active ingredient.
In addition to the oral form of acetaminophen, there is another form of acetaminophen: through the anal administration of the dosage form, that is, suppositories. In foreign countries, anal administration is common, but most Chinese people have difficulty accepting this form of medication due to our culture.
However, in some cases, such as when feeding a baby, the baby will vomit, or when the baby has a high fever at night and you don’t want to wake the baby up, it is much easier to use an anal suppository.
The absorption of suppositories does not go through the liver and does not irritate the gastrointestinal tract, and it works faster than the oral way because the drug goes directly from the intestinal mucosa into the bloodstream.
However, from the perspective of absorption rate, the oral absorption rate is high, while the suppository absorption rate is a little lower because the drug is absorbed through the mucous membrane. Therefore, the maximum oral dose is generally 15 mg per kg of body weight per dose, and when using suppositories, the dose should be correspondingly larger, and the maximum dose can be 20 mg per kg of body weight per dose.
Suppositories are not used much in China, leading some parents to think that there are no fever suppositories in China, so they will go to the Internet to poke around. In fact, this is risky, because the drug back from the sea, the instructions are written in the local language, it is easy to misuse.
2, ibuprofen: alternative antipyretic, for children and adults over 6 months of age
When reducing fever in patients with silicosis, that is, hereditary glucose-6-phosphate dehydrogenase (G6PD) deficiency, acetaminophen should be avoided, but ibuprofen can be used. Ibuprofen may also be considered to reduce fever in patients who have failed to reduce fever with acetaminophen. Well-known medications that use ibuprofen as a single active ingredient include Merlin and Fenbendazole.
The daily dosage of ibuprofen for children is 5 mg-10 mg per kilogram of body weight per dose, every 6 hours, up to 4 times a day. The regular dosage for adults is 200-400 mg per dose, every 6-8 hours, up to 4 times a day, with a maximum dose of 2400 mg. It is safe to use any dose that does not exceed the maximum.
Ibuprofen has a strong antipyretic effect and the process of reducing fever causes the body to sweat a lot, so ibuprofen is not suitable for patients with symptoms of dehydration to reduce fever.
Also, ibuprofen is excreted through the kidneys and should be used with caution in patients with poor kidney function. Adverse effects of ibuprofen also include the possibility of inducing asthma and should be used with caution in babies with asthma. This drug is safe to use in accordance with the recommended dose, but an overdose can easily cause kidney damage.
3. Consider alternating acetaminophen and ibuprofen only if the fever persists
The minimum time interval between acetaminophen administration is 4 hours. When the fever has not gone down after two hours of acetaminophen at the maximum dose, only ibuprofen can be used alternately, and the minimum time interval between the alternate use of these two drugs is two hours. When alternating, the maximum number of times each drug can be used per day remains the same, i.e., up to 5 times for acetaminophen and up to 4 times for ibuprofen.
It is important to note that when a fever can be reduced with only two or three antipyretics a day, I recommend choosing a single antipyretic, as each additional drug doubles the risk of taking the wrong medication. Therefore do not alternate between two kinds of fever-reducing medications when the fever can be controlled with one kind of fever-reducing medication.
In addition, it is also important to drink a small amount of water several times when taking medicine to reduce fever to speed up the excretion process and help take away body heat. At the same time, it is also necessary to take medicine to reduce fever along with physical cooling, but do not use alcohol wipes, especially for children, as alcohol can easily pass through the child’s tender skin and lead to alcohol poisoning.