• Mark DiachinskyEmail author


Fever, or pyrexia, is an elevation of body temperature above the normal range. Fever is most commonly defined as a body temperature greater than 38 °C; however, the defining criteria may differ among individuals. Fever is a complex physiological response most commonly associated with infectious causes (bacterial or viral infections) but may also be caused by non-infectious diseases such as immune-mediated or inflammatory diseases, drug causes, or malignancies. Fever is a normal immune response that is rarely harmful and often does not require treatment with medications. Assessment of patients presenting with a fever requires knowledge of the variations in temperature among individuals and among different sites of measurement of body temperature. Assessment of the history and characteristics of a fever and the presence of any associated symptoms are essential. It is important to determine if any red flags are present, as they could be indicative of a serious bacterial infection or adverse drug reaction, which can be life-threatening. Pharmacists play an important role in the assessment of patients with fever. By obtaining a focused clinical history from the patient, they can identify patients who need to be referred to their physician or to the emergency room, as well as which patients can be managed at home. Pharmacists should also be aware of some of the challenges of medication use in children and the various antipyretic formulations available.


Fever Pyrexia Hyperthermia Thermoregulation Infection Drug fever Antipyretics Acetaminophen NSAIDs 


  1. 1.
    Mackowiak PA, Bartlett JG, Borden EC, Goldblum SE, Hasday JD, Munford RS, et al. Concepts of fever: recent advances and lingering dogma. Clin Infect Dis. 1997;25(1):119–38.CrossRefGoogle Scholar
  2. 2.
    Barbi E, Marzuillo P, Neri E, Naviglio S, Krauss BS. Fever in Children: Pearls and Pitfalls. Children. 2017;4(9):pii: E81.CrossRefGoogle Scholar
  3. 3.
    DeWitt S, Chavez SA, Perkins J, Long B, Koyfman A. Evaluation of fever in the emergency department. Am J Emerg Med. 2017;35(11):1755–8.CrossRefGoogle Scholar
  4. 4.
    Emergency Department Visits in 2014–2015 [Internet]. Candian Institute for Health Information; c2014-2015 [cited 2018 May 1]. Available from:
  5. 5.
    Biddle C. The neurobiology of the human febrile response. AANA J. 2006;74(2):145–50.PubMedGoogle Scholar
  6. 6.
    Dascombe MJ. The pharmacology of fever. Prog Neurobiol. 1985;25(4):327–73.CrossRefGoogle Scholar
  7. 7.
    Lyon DM. The relation of pulse-rate to temperature in febrile conditions. Qu J Med. 1927;20(78):205–18.CrossRefGoogle Scholar
  8. 8.
    Tanner JM. The relationships between the frequency of the heart, oral. temperature and rectal temperature in man at rest. J Physiol. 1951;115:391–409.CrossRefGoogle Scholar
  9. 9.
    Strengell T, Uhari M, Tarkka R, Uusimaa J, Alen R, Lautala P, et al. Antipyretic agents for preventing recurrences of febrile seizures: Randomized controlled trial. Arch Pediatr Adolesc Med. 2009;163:799–804.CrossRefGoogle Scholar
  10. 10.
    Shevchuk YM. Chapter 9 fever. In: Carol CPHA, editor. Patient self-care: helping your patients make therapeutic choices. 2nd ed. Ottawa: Canadian Pharmacists Association; 2010. p. 80–93.Google Scholar
  11. 11.
    Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005;71(11):2133–40.PubMedGoogle Scholar
  12. 12.
    Hensyl WR, editor. Steadman’s medical dictionary. 25th ed. Baltimore: Williams & Wilkins; 1990. p. 574.Google Scholar
  13. 13.
    Mackowiak PA, Wasserman SS, Levine MM. A critical appraisal of 98.67 degrees F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. JAMA. 1992;268(12):1578–80.CrossRefGoogle Scholar
  14. 14.
    Wunderlich CA, Seguin E. Medical thermometry and human temperature. New York: William Wood & Co. p. 1871.Google Scholar
  15. 15.
    Dinarello CA, Wolff SM. Pathogenesis of fever in man. N Engl J Med. 1978;298(11):607–12.CrossRefGoogle Scholar
  16. 16.
    Baker FC, Driver HS. Circadian rhythms, sleep, and the menstrual cycle. Sleep Med. 2007;8(6):613–22.CrossRefGoogle Scholar
  17. 17.
    Jones SR. Fever in the elderly. In: Mackowiak PA, editor. Fever: basic mechanisms and management. New York: Raven Press; 1991. p. 233–42.Google Scholar
  18. 18.
    Lorin MI. Fever: pathogenesis and treatment. In: Feigin RD, Cherry JD, editors. Textbook of pediatric infectious diseases, vol. 1. 3rd ed. Philadelphia: WB Saunders; 1992. p. 130–6.Google Scholar
  19. 19.
    Taylor NAS, Tipton MJ, Kenny GP. Considerations for the measurement of core, skin and mean body temperatures. J Therm Biol. 2014 Dec;46:72–101.CrossRefGoogle Scholar
  20. 20.
    Wyckoff SA. Thermometer use 101. American Academy of Pediatrics [Internet]. 2009 Nov [cited 2018 May 1]; 30(11):[about 1 p.]. Available from:
  21. 21.
    Leduc D, Woods S, editors. Temperature measurement in paediatrics [Internet]. Canadian Paediatric Society; 2017 [cited 2018 May 1]. Available from:
  22. 22.
    National Institute for Health and Care Excellence [Internet]. London; c2013-2018 [cited 2018 May 1]. Fever in under 5s: assessment and initial management. Available from:
  23. 23.
    El-Radhi AS. Determining fever in children: the search for an ideal thermometer. Br J Nurs. 2014;23(2):91–4.CrossRefGoogle Scholar
  24. 24.
    Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Infectious diseases society of America clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis. 2011;52(4):e56–93.CrossRefGoogle Scholar
  25. 25.
    Outzen M. Management of fever in older adults. J Gerontol Nurs. 2009;35(5):17–23.CrossRefGoogle Scholar
  26. 26.
    Cuddy ML. The effects of drugs on thermoregulation. AACN Clin Issues. 2004;15(2):238–53.PubMedGoogle Scholar
  27. 27.
    O’Mara SK. Management of postoperative fever in adult cardiac surgical patients. Dimens Crit Care Nurs. 2017;36(3):182–92.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Stollery Children’s Hospital, Alberta Health Services, Pharmacy ServicesEdmontonCanada

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