Drug+fever

[] The recognition of drug fever is clinically important. Failure to recognize the etiologic relationship between a drug and fever has unnecessary consequences including extra testing, empiric therapy, and longer hospital stays. — For the purpose of this discussion, drug fever will be defined as "** a disorder characterized by fever coinciding with the administration of the drug and disappearing after the discontinuation of the drug **, ** when no other cause for the fever is evident after a careful physical examination and laboratory investigation **" [[|6]]. Other have applied definitions such as "the febrile response to a drug without cutaneous manifestations" [[|7]], but, in our view, such a definition is overly restrictive. Data on drug fever are largely derived from hundreds of single case reports and a few small series. There are no controlled trials on this subject, and reporting bias may significantly distort our view. — The mechanisms of drug fever are multiple and, in many cases, are poorly or incompletely understood. However, most authorities classify drug-related fevers into five broad categories [[|1,2,7,8]]. — Hypersensitivity is the most common cause of drug fever [[|1-3,6-8]]. Various mechanisms can cause fever, including the formation of circulating antibody-antigen complexes and/or a T-cell immune response provoked by a drug or its metabolites. Any one episode may involve multiple antigenic determinants and mechanisms. Fever is occasionally recognized when certain drugs are used in combination, such as methotrexate and azathioprine in the treatment of refractory rheumatoid arthritis [[|9]]. [] []
 * Drug fever **
 * Medications with a Potential for inducing a fever ||
 * allopurinol || antihistamines ||
 * azathioprine || barbiturates ||
 * carbamazepine || cephalosporins ||
 * cimetidine || folic acid ||
 * hydralazine || hydroxyurea ||
 * ** ibuprofen ** || ** isoniazid ** ||
 * methyldopa || nitrofurantoin ||
 * penicillins || ** phenytoin (dilantin) ** ||
 * procainamide || prophylthiouracil ||
 * quinidine || streptomycin ||
 * sulfonamides || sulindac ||
 * triamterene || vancomycin ||
 * ** — Clinicians are universally aware of the common occurrence of fever caused by drugs although reliable data on incidence are not available. Fever can be the sole manifestation of an adverse drug reaction in three to five percent of cases [[|1,2]]. The risk of developing drug fever increases with the number of drugs prescribed, especially in the elderly. Patients with HIV infection also appear to have an increased susceptibility to drug reactions of all types, including fever [[|3-5]].
 * Hypersensitivity reactions
 * Altered thermoregulatory mechanisms
 * Directly related to administration of the drug
 * Direct extension of the pharmacologic action of the drug
 * Idiosyncratic reactions
 * Reference**