It is unclear whether fever suppression in the elderly provides long-term benefits or poses risks due to their distinct immune profiles and body temperature regulation compared to younger individuals.
Long-term health effects of antipyretic drug use in the aging population: a systematic review
Seema Mahesh1,2,3* , Esther van der Werf4,5 , Mahesh Mallappa2 , George Vithoulkas3,6 , Nai Ming Lai1
1. Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
2. Centre For Classical Homeopathy, Bengaluru, India
3. International Academy of Classical Homeopathy, Alonissos, Greece
4. Homeopathy Research Institute, London, United Kingdom
5. Bristol Medical School, University of Bristol, Bristol, United Kingdom
6. University of the Aegean, Mytilene, Greece
*Corresponding author
Seema Mahesh
Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
Centre For Classical Homeopathy, Bengaluru, India
International Academy of Classical Homeopathy, Alonissos, Greece
E-mail: bhatseema@hotmail.com
DOI
10.25122/jml-2024-0081
Dates
Received: 15 February 2024
Accepted: 22 August 2024
ABSTRACT
It is unclear whether fever suppression in the elderly provides long-term benefits or poses risks due to their distinct
immune profiles and body temperature regulation compared to younger individuals. This study aimed to assess the
long-term health effects of antipyretic treatment during infections in the elderly. A systematic review was conducted,
including studies that compared antipyretic treatment with other drugs, therapies, placebo, or no treatment. PubMed,
Embase and Cochrane CENTRAL databases were searched. Primary and secondary outcomes were the onset or
worsening of chronic inflammatory diseases, fever reduction, length of hospital stay, patient satisfaction, mortality,
laboratory indicators of morbidity, and progression to complications, respectively. Out of 11,481 studies screened,
17 were included (two randomized controlled trials [RCTs], seven observational studies, one case series, and seven
case reports). None investigated the primary outcome or patient-reported outcomes. The risk of bias in the included
studies ranged from unclear to high. Due to the heterogeneity of the studies, a narrative synthesis was conducted, as
meta-analysis was not feasible. Antipyretics showed a significant reduction of fever in RCTs. Five studies reported a
significant drop in blood pressure, and one showed significant mortality from antipyretics. Morbidity indicators and
length of stay were available only in the studies that reported adverse events. The certainty of evidence, assessed
using GRADE, was low to very low for all outcomes. Evidence regarding the long-term benefit or harm from fever
suppression with antipyretics during infections in the elderly is insufficient.
KEYWORDS: antipyretics, aged, systematic review, inflammation, fever, immunosenescence, acetaminophen, nonsteroidal anti-inflammatory agents