Effect of using vinegar compresses combined with antipyretic drug and only antipyretic drug in the management of fever: A comparative study

Abstract

Background: Fever is among the most common reasons for pediatric emergency visits, and caregivers frequently combine pharmacological and physical strategies to reduce body temperature. Antipyret-ics such as paracetamol are widely used, while vinegar compresses remain a common complementary practice; however, their short-term added benefit in clinical settings is not well established. Objec-tive: To compare short-term temperature reduction after (i) cider apple vinegar compresses combined with intravenous (IV) paracetamol and (ii) IV paracetamol alone among febrile children. Methods: A quasi-experimental study was conducted in the emergency department of Karbala Teaching Hospital for Children (May–August 2025). One hundred and twenty children (2–7 years) with axillary temperature >37.5^◦C were enrolled and allocated in a 1:1 ratio to a vinegar compresses + IV paracetamol group or an IV paracetamol-only group. Axillary temperature was recorded at baseline and at 15-minute intervals for 60 minutes after the intervention. Descriptive statistics were computed; within-group temperature changes across time were evaluated using the Friedman test, and between-group comparisons at each time point were assessed using the non-parametric Mann–Whitney U test (SPSS v26). Results: Both groups showed decreasing mean temperature over time, with a larger and more rapid decline observed descriptively in the vinegar compresses + paracetamol group. Within-group analysis showed a statisti-cally significant reduction across time points in the combined-intervention group, with a large effect size, whereas changes in the paracetamol-only group were smaller over the same 60-minute window. Con-clusion: IV paracetamol remains an effective first-line intervention for febrile children in the ED. When used as an adjunct to antipyretic therapy, vinegar compresses may accelerate short-term temperature reduction in the first hour after treatment. Given the quasi-experimental design and pragmatic imple-mentation, confirmatory randomized trials with standardized compress preparation, safety monitoring, and longer follow-up are recommended before broad practice changes. Recommendations: Nurses and caregivers should be educated that complementary physical measures, if used, should be applied as adjuncts (not substitutes) to evidence-based antipyretic therapy, with attention to comfort and skin integrity. Future studies should incorporate randomization, detailed intervention standardization, and clinically meaningful outcomes beyond short-term temperature change.