Antipyretic measures for treating fever in malaria

Abstract

Background: Fever control measures are commonly used in treating malaria. Some researchers have suggested that fever reduction may prolong malaria illness. Objectives: We aim to assess whether antipyretic measures in malaria influences outcome, measured by length of illness, parasitaemia, and occurrence of convulsions. Search strategy: We searched the Cochrane Infectious Diseases Group Trial Register (December 2002), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2002), MEDLINE (1966 to December 2002); EMBASE (1980 to December 2002), LILACS (December 2002). We contacted researchers and organisations working in the field. Selection criteria: Randomised or pseudo-randomised trials which compared antipyretic drugs with mechanical or no antipyretic measures in patients with slide-confirmed malaria. Data collection and analysis: 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. Main results: 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. Authors' conclusions: There is insufficient data to confirm or refute an impact of antipyretic measures on parasitaemia or malarial illness