Antipyretics Do Not Change Mortality in Septic Patients

by Joseph Esherick, M.D., FAAFP, FHM

Fever is universally treated in the setting of infection in virtually all hospitals, but does treatment of fever improve outcomes in patients with sepsis?

This meta-analysis of eight randomized trials (1507 patients) and six observational studies (2058 patients) that compared outcomes in adult patients with sepsis according to whether or not they were treated with antipyretics. Two additional observational studies examined early mortality in 15,374 patients.

The meta-analysis showed that 28-day mortality was not significantly different between patients who received antipyretics versus those who did not (relative risk, 0.93; 95% confidence interval, 0.79–1.09). Moreover, no significant between-group differences were observed in the secondary outcomes of post-

intervention heart rate, minute ventilation, rates of nosocomial infections, and shock reversal.

The interventions that do reduce mortality in sepsis are early aggressive fluid resuscitation, early antibiotics and source control. Antipyretics might make your patients more comfortable, but they have no effect on mortality.

Reference:

  1. Drewry AM et al. Antipyretic therapy in critically ill septic patients: A systematic review and meta-analysis. Crit Care Med 2017 Feb 17