Drug fever and hyperthermia

Drug fever is a febrile reaction that coincides in time with and is pathogenetically associated with the use of a drug. The review presents publications of epidemiological and clinical studies on various variants of fever development due to the use of pharmacological agents. Febrile reactions associated with both immune hypersensitivity and those with other mechanisms of development, as well as drug hypersensitivity syndromes, including fever as one of the syndromes (drug-induced hypersensitivity syndrome, serum sickness, drug-induced lupus), are considered. Most often, the term “drug fever” is used to define cases with isolated febrile increase in body temperature, not accompanied by other clinical symptoms (for example, rash or organ damage), and having an immune genesis. An association of drug fever with an extremely wide range of drugs has been established, but most often it is caused by beta-lactam antibiotics. There is a high probability of drug fever in intensive care unit patients who have a high risk of bacterial infection and receive long courses of antibiotics. Underdiagnosis of drug fever leads to unjustified continuation and intensification of antibacterial therapy, increased risk of iatrogenic complications and economic costs. The review also presents variants of drug hyperthermia: malignant neuroleptic syndrome, malignant hyperthermia, serotonin syndrome, propofol infusion syndrome and some others. Despite the long history of studying the issue, the pathogenesis of the pathology remains not entirely clear, there are no specific diagnostic markers and the diagnosis is still made by exclusion.