Antipyretic measures for treating fever in malaria

Fever control measures are commonly used in treating malaria. Some researchers have suggested that fever reduction may prolong malaria illness. We aim to assess whether antipyretic measures in malaria influences outcome, measured by length of illness, parasitaemia, and occurrence of convulsions.

We searched the Cochrane infectious Diseases Group Trial Register, the Cochrane Controlled Trial Register, and other electronic bibliographies, and contacted researchers and organizations working in this field.

Randomised or pseudo-randomised trials which compared antipyretic drugs with mechanical or no antipyretic measures in patients with slide-confirmed malaria.

Inclusion criteria were independently applied by two reviewers. We extracted data from selected trials using a standard form. Weighted mean difference with 95% confidence interval was calculated for continuous data.

Three randomised trials with pooled 128 adults and children with falciparum malaria; all unblinded; allocation concealment unclear in two. Inconsistent pattern of fever clearance between trials, but malaria cure rate reported to be similar between intervention and control in all trials. Mean parasite clearance time reported to be similar in one trial but longer in paracetamol group in two trials: sample size in one trial was too small to conclude anything (n=7), while the other trial was difficult to evaluate.

There is no statistically significant data to draw any conclusions. The clinical significance of preliminary report suggesting that antipyretic drugs prolong malaria parasitaemia was not confirmed.