Drug fever: Difference between revisions
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==Background== |
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* A drug reaction of unclear mechanism that causes isolated fever |
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*A drug reaction of unclear mechanism that causes isolated fever |
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== Pathophysiology == |
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* Stipulated to involve any of five mechanisms: |
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** Altered thermoregulation, including anticholinergics |
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** Drug administration-related fever, including [[amphotericin B]], cephalosporins, and [[vancomycin]] |
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** Expected drug effect, including chemotherapy (tumour lysis) and penicillins ([[Jarisch-Herxheimer reaction]]) |
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** Idiosyncratic reactions, including [[primaquine]], [[quinidine]], [[quinine]], and sulfonamides |
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** Hypersensitivity reaction, including allopurinol, [[quinidine]], [[quinine]], and sulfonamides |
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===Pathophysiology=== |
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== Etiology == |
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* Antimicrobials are the most common overall class[[CiteRef::mackowiak1987dr]][[CiteRef::patel2010dr]] |
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** 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]] |
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** [[Tetracycline]] and [[minocyline]] |
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** [[Trimethoprim-sulfamethoxazole]] |
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** [[Isoniazid]] |
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** [[Nitrofurantoin]] |
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** Case reports of [[acyclovir]], [[amphotericin B]], [[aureomycin]], [[colistin]], [[declomycin]], [[erythromycin]], [[furadantin]], [[mebendazole]], [[novobiocin]], [[para-aminosalicylic acid]], [[rifampin]], [[streptomycin]], [[terramycin]], and [[vancomycin]] |
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* Cardiovascular |
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** Methyldopa |
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** Quinidine and quinine |
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** Procainamide |
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** Dobutamine |
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** Case reports with clofibrate, diltiazem, furosemide, heparin, hydralazine, hydrochlorothiazide, nifedipine, oxprenelol, and triameterene |
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* Neurologic medications |
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** Phenytoin is the most common within this class |
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** Lysergic acid |
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** Carbamazepine |
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** Nomifensine |
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** Thioradazine |
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** Case reports of amphetamine, doxepin, haloperidol, nomifensine, sulfasalazine, triamterene, benztropine, and trifluoperazine |
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* Chemotherapy and immunomodulators |
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** Bleomycin |
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** Streptomycin |
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** Case reports of 6-mercaptopurine, chlorambucil, cisplatin, cytarabine, cytosine arabinoside, daunorubicin, hydroxyurea, L-asparaginase, procarbazine, streptozocin, and vincristine |
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* Antiinflammatory or immunomodulatory medications |
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** Azathioprine |
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** NSAIDs, including ibuprofen, tolmetin, and aspirin |
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** Case reports of everolimus, mycophenolate mofetil, and sirolimus |
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* Other medications, including allopurinol, cimetidine, clofibrate, folate, interferon, iodide, levamisole, metoclopramide, piperazine, propylthiouracil, prostaglandin E2, ritodrine, theeophylline, and thyroxine |
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*Stipulated to involve any of five mechanisms: |
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== Clinical Presentation == |
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**Altered thermoregulation, including anticholinergics |
|||
* Fever without focus and no other likely causes |
|||
**Drug administration-related fever, including [[amphotericin B]], cephalosporins, and [[vancomycin]] |
|||
* Can occur at any point in administration of the medication, but most often 7 to 10 days after starting |
|||
**Expected drug effect, including chemotherapy (tumour lysis) and penicillins ([[Jarisch-Herxheimer reaction]]) |
|||
* Fever pattern was mostly unpredictable, but could be intermittent or remittent (high but fluctuating); rarely continuous |
|||
**Idiosyncratic reactions, including [[primaquine]], [[quinidine]], [[quinine]], and sulfonamides |
|||
* Fever most commonly high, but could be low-grade |
|||
**Hypersensitivity reaction, including allopurinol, [[quinidine]], [[quinine]], and sulfonamides |
|||
* Usually appear well, even when febrile, including a relative bradycardia |
|||
* Many have rigors, and may occasionally have other systemic signs or symptoms |
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* Occasional leukocytosis or eosinophilia |
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===Etiology=== |
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== Further Reading == |
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* Drug fever. ''Pharmacotherapy''. 2010;30(1):57-69. doi: [https://doi.org/10.1592/phco.30.1.57 10.1592/phco.30.1.57] |
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*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 |
|||
**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]] |
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*Cardiovascular |
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**[[Methyldopa]] |
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**[[Quinidine]] and [[quinine]] |
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**[[Procainamide]] |
|||
**[[Dobutamine]] |
|||
**Case reports with [[clofibrate]], [[diltiazem]], [[furosemide]], [[heparin]], [[hydralazine]], [[hydrochlorothiazide]], [[nifedipine]], [[oxprenelol]], and [[triameterene]] |
|||
*Neurologic medications |
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**[[Phenytoin]] is the most common within this class |
|||
**[[Dexmedetomidine]] |
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**[[Lysergic acid]] |
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**[[Carbamazepine]] |
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**[[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]] |
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==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== |
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*Stop offending medication |
|||
==Further Reading== |
|||
*Drug fever. ''Pharmacotherapy''. 2010;30(1):57-69. doi: [https://doi.org/10.1592/phco.30.1.57 10.1592/phco.30.1.57] |
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[[Category:Fever syndromes]] |
[[Category:Fever syndromes]] |
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Latest revision as of 19:48, 14 December 2022
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.
