Drug fever: Difference between revisions
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*Long list of offending medication, mostly based on collections of case reports[[CiteRef::mackowiak1987dr]][[CiteRef::patel2010dr]] |
*Long list of offending medication, mostly based on collections of case reports[[CiteRef::mackowiak1987dr]][[CiteRef::patel2010dr]] |
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*Antimicrobials are the most common overall class |
*'''Antimicrobials are the most common overall class''' |
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**Penicillins are most common, including [[penicillin]], [[piperacillin]], [[ticarcillin]] [[ampicillin]], [[methicillin]], [[carbenicillin]], [[mezlocillin]], [[staphcillin]], [[nafcillin]], [[oxacillin]], and [[cloxacillin]] |
**'''Penicillins''' are most common, including [[penicillin]], [[piperacillin]], [[ticarcillin]] [[ampicillin]], [[methicillin]], [[carbenicillin]], [[mezlocillin]], [[staphcillin]], [[nafcillin]], [[oxacillin]], and [[cloxacillin]] |
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**Cephalosporins, including [[cefazolin]], [[cefotaxime]], [[ceftazidime]], [[cephalexin]], and [[cephalothin]] |
**Cephalosporins, including [[cefazolin]], [[cefotaxime]], [[ceftazidime]], [[cephalexin]], and [[cephalothin]] |
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**[[Tetracycline]] and [[minocyline]] |
**[[Tetracycline]] and [[minocyline]] |
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**Case reports with [[clofibrate]], [[diltiazem]], [[furosemide]], [[heparin]], [[hydralazine]], [[hydrochlorothiazide]], [[nifedipine]], [[oxprenelol]], and [[triameterene]] |
**Case reports with [[clofibrate]], [[diltiazem]], [[furosemide]], [[heparin]], [[hydralazine]], [[hydrochlorothiazide]], [[nifedipine]], [[oxprenelol]], and [[triameterene]] |
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*Neurologic medications |
*Neurologic medications |
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**[[Phenytoin]] is the most common within this class |
**'''[[Phenytoin]]''' is the most common within this class |
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**[[Dexmedetomidine]] |
**[[Dexmedetomidine]] |
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**[[Lysergic acid]] |
**[[Lysergic acid]] |
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Latest revision as of 18:40, 6 January 2026
Background
- A drug reaction of unclear mechanism that causes isolated fever
Pathophysiology
- Stipulated to involve any of five mechanisms:
- Altered thermoregulation, including anticholinergics
- Drug administration-related fever, including amphotericin B, cephalosporins, and vancomycin
- Expected drug effect, including chemotherapy (tumour lysis) and penicillins (Jarisch-Herxheimer reaction)
- Idiosyncratic reactions, including primaquine, quinidine, quinine, and sulfonamides
- Hypersensitivity reaction, including allopurinol, quinidine, quinine, and sulfonamides
Etiology
- Long list of offending medication, mostly based on collections of case reports12
- Antimicrobials are the most common overall class
- Penicillins are most common, including penicillin, piperacillin, ticarcillin ampicillin, methicillin, carbenicillin, mezlocillin, staphcillin, nafcillin, oxacillin, and cloxacillin
- Cephalosporins, including cefazolin, cefotaxime, ceftazidime, cephalexin, and cephalothin
- Tetracycline and minocyline
- Trimethoprim-sulfamethoxazole
- Isoniazid
- Nitrofurantoin
- Case reports of acyclovir, amphotericin B, aureomycin, colistin, declomycin, erythromycin, furadantin, mebendazole, novobiocin, para-aminosalicylic acid, rifampin, streptomycin, terramycin, and vancomycin
- Cardiovascular
- Methyldopa
- Quinidine and quinine
- Procainamide
- Dobutamine
- Case reports with clofibrate, diltiazem, furosemide, heparin, hydralazine, hydrochlorothiazide, nifedipine, oxprenelol, and triameterene
- Neurologic medications
- Phenytoin is the most common within this class
- Dexmedetomidine
- Lysergic acid
- Carbamazepine
- Nomifensine
- Thioradazine
- Case reports of amphetamine, doxepin, haloperidol, nomifensine, sulfasalazine, triamterene, benztropine, and trifluoperazine
- Chemotherapy and immunomodulators
- Bleomycin
- Streptomycin
- Case reports of 6-mercaptopurine, chlorambucil, cisplatin, cytarabine, cytosine arabinoside, daunorubicin, hydroxyurea, L-asparaginase, procarbazine, streptozocin, and vincristine
- Antiinflammatory or immunomodulatory medications
- Azathioprine
- NSAIDs, including ibuprofen, tolmetin, and aspirin
- Case reports of everolimus, mycophenolate mofetil, and sirolimus
- Other medications, including allopurinol, cimetidine, clofibrate, folate, interferon, iodide, levamisole, metoclopramide, piperazine, propylthiouracil, prostaglandin E2, ritodrine, theophylline, and thyroxine
Clinical Manifestations
- Fever without focus and no other likely causes
- Can occur at any point in administration of the medication, but most often 7 to 10 days after starting
- Fever pattern was mostly unpredictable, but could be intermittent or remittent (high but fluctuating); rarely continuous
- Fever most commonly high, but could be low-grade
- Usually appear well, even when febrile, including a relative bradycardia
- Many have rigors, and may occasionally have other systemic signs or symptoms
- Occasional leukocytosis or eosinophilia
Management
- Stop offending medication
Further Reading
- Drug fever. Pharmacotherapy. 2010;30(1):57-69. doi: 10.1592/phco.30.1.57
References
- ^ Philip A. Mackowiak. Drug Fever: A Critical Appraisal of Conventional Concepts. Annals of Internal Medicine. 1987;106(5):728. doi:10.7326/0003-4819-106-5-728.
- ^ Ruchi A Patel, Jason C Gallagher. Drug Fever. Pharmacotherapy. 2010;30(1):57-69. doi:10.1592/phco.30.1.57.
