Novel Therapeutic Approach Using Proton Pump Inhibitor and Antiemetic Combination for Refractory Fever and Headache: A Case Series

Delayed gastric emptying during acute illness may prevent adequate medication absorption, causing therapeutic failure. We present three cases of refractory fever and headache that responded rapidly to proton pump inhibitor and antiemetic combinations. A 60-year-old female with severe headache unresponsive to paracetamol and mefenamic acid experienced complete relief 15 minutes after receiving pantoprazole 40mg with domperidone 30mg. A six-year-old with fever persisting at 101°F despite ibuprofen achieved defervescence within 20 minutes of lansoprazole 15mg with ondansetron 0.15mg/kg. A two-year-old with febrile seizure and persistent fever at 102°F unresponsive to combination antipyretics normalized temperature within 15 minutes of lansoprazole 15mg with ondansetron 0.15mg/kg. We hypothesize that acute illness induces transient gastroparesis impairing drug absorption, and that PPI-antiemetic combinations restore gastric function allowing absorption of previously administered but unabsorbed medications. This warrants controlled investigation.