- Paracetamol is considered the first-line medication for managing fever in adults due to its effective antipyretic action and favorable safety profile.
- It reduces fever by inhibiting prostaglandin synthesis in the hypothalamic heat-regulating centre without significant anti-inflammatory effects or gastrointestinal toxicity.
- Unlike NSAIDs such as ibuprofen or aspirin, paracetamol does not cause platelet dysfunction or gastric irritation, making it safer for most patients.
- Aspirin is generally avoided in adults for fever due to the risk of Reye’s syndrome and bleeding.
- Hence, paracetamol remains the preferred initial treatment for fever.

Reference: Davidson’s Principles and Practice of Medicine, 23rd Edition, Chapter: Approach to the Patient, Page 37.