Drug Fever

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Drug Fever

• 2001/05/21
• By Ri ???
• Edited By Ri ???

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Drug Fever

• The febrile response to a drug
• without cutaneous manifestations

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Mechanisms of Drug Fever

• 1. Altered Thermoregulatory Mechanisms
• 2. Drug Administration
• 3. Pharmacologic Effects---
• Jarisch-Herxheimer reaction
• 4. Idiosyncratic Reactions
• 5. Immune-Mediated/
• Hypersensitivity Reactions

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Clinical Features -------History

• Any time
• (Frequently after 12 wks of therapy)
• Some individuals are atopic
• A negative allergic history does not rule out
  drug fever

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Clinical Features -------Physical Exam

• Low- to high- grade fevers
• may range from 99?109? (46?)
• 38.8?40.0? most common
• No typical fever pattern
• Relative bradycardia
• after R/O conduction abnormality
• Look inappropriately well for degree of fever

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Clinical Features -------Physical Exam

• Rash (Uncommon)
• generalized maculopapular rash
• urticarial or petechial component
• may be pruritic
• central,may involve palms soles

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Clinical Features -------Laboratory Tests

• Elevated WBC count (usually with left shift)
• Eosinophils ()
• Eosinophilia is uncommon(lt 20)
• Elevated ESR (common may gt 100mm/hr)
• Mild elevation of ALP or GOT/GPT (gt 90)

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Diagnosis

• Clinical suspicion
• A fever occurs despite clinical improvement
• No obvious source of temperature
• Discontinue the drug-----
• rapid resolution of the fever within 72 hours
• if no rash is present

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Treatment

• Discontinue all potentially causative medicines,
  together or sequentially
• Rechallenge will usually cause recurrence of
  fever within a few hours, confirming the diagnosis

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Which Kind of Drug ?

• Common
• Atropine
• Amphotericin B
• Asparaginase
• Barbiturates
• Bleomycin
• Methyldopa
• Penicillins

• Cephalosporins
• Phenytoin
• Procainamide
• Quinidine
• Salicylates
• Sulfonamides
• Interferon

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Which Kind of Drug ?

• Less Common
• Allopurinol
• Azathioprine
• Cimetidine
• Hydralazine
• Iodides
• Isoniazid
• Rifampin

• Streptokinase
• Imipenem
• Vancomycin
• Nifedipine
• NSAIDs
• Metoclopramide

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Which Kind of Drug ?

• Rare
• Salicylates
• (therapeutic doses)
• Corticosteroids
• Aminoglycosides
• Macrolides
• Tetracyclines

• Clindamycin
• Chloramphenicol
• Vitamin preparations