Antipyretic therapy

Antipyresis can be achieved by physical methods such as cooling the body with tepid water or by pharmacological means such as the administration of antipyretic drugs. The nonsteroid anti-inflammatory drugs (NSAIDs) including aspirin, have been used to combat fever since the end of the 19th century and the analgesic antipyretics, from about the same time. Most of the antipyretic analgesics such as acetanilide and phenacetin are no longer used in therapy because of their toxicity. However, the metabolite of these two drugs, acetaminophen, became a highly popular antipyretic in the 1950s and is now the antipyretic of first choice in most developed countries. The disadvantages of administering NSAIDs is their gastrotoxicity manifested as irritation, ulcers and bleeding of the stomach mucosa. Acetaminophen also is toxic to the liver in doses only slightly above the therapeutic dose. Thus, selective COX-2 inhibitors, which do not damage the stomach and are free fom hepatotoxicity, may be the drugs of choice for reducing fever in the future.