Drug fever: Difference between revisions
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| + | ==Background== |
||
| − | * A drug reaction of unclear mechanism that causes isolated fever |
||
| + | *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 |
||
| + | ===Pathophysiology=== |
||
| − | == Etiology == |
||
| − | * Long list of offending medication, mostly based on collections of case reports[[CiteRef::mackowiak1987dr]][[CiteRef::patel2010dr]] |
||
| − | * 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 |
||
| − | ** 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, theeophylline, and thyroxine |
||
| + | *Stipulated to involve any of five mechanisms: |
||
| − | == Clinical Presentation == |
||
| + | **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 |
||
| − | * Occasional leukocytosis or eosinophilia |
||
| + | ===Etiology=== |
||
| − | == 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] |
||
| + | *Long list of offending medication, mostly based on collections of case reports[[CiteRef::mackowiak1987dr]][[CiteRef::patel2010dr]] |
||
| + | *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: [https://doi.org/10.1592/phco.30.1.57 10.1592/phco.30.1.57] |
||
[[Category:Fever syndromes]] |
[[Category:Fever syndromes]] |
||
Latest revision as of 15:48, 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.
