Fever refractory to standard antipyretics

Fever not relieved by standard doses of paracetamol or ibuprofen at correct dosing intervals. Requires diagnostic reassessment, source search, and consideration of backup antipyretics.

ICD-10 R50.92 drugs

Also known as: Refractory fever

Drugs used for this condition

BMetamizole sodiumSecond line · Analgesics and antipyretics. PyrazolonesFor fever refractory to standard antipyretics (paracetamol, ibuprofen), metamizole may be used as a reserve in adults. It is most often justified in inpatient settings in infectious patients. Pediatric use for fever is discouraged in most international guidelines due to agranulocytosis risk.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

FNimesulideNot recommended · Antiinflammatory and antirheumatic agents, non-steroids. Other NSAIDsNimesulide is not used as an antipyretic in children and is not preferred in adult fever. EMA 2011 banned use in children under 12. In adults with fever, paracetamol and ibuprofen with more favorable safety profiles are preferred.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit