The efficacy and safety of rectally administered nimesulide 200mg and paracetamol 500mg were assessed in a double-blind study. The study was conducted in 39 elderly inpatients with infections of the upper or lower respiratory tract associated with fever; 18 patients received nimesulide and 21 received paracetamol. Both treatments were given for 2 consecutive days and provided adequate therapy for pyrexia, with significant reductions in body temperature being observed. Both drugs were well tolerated. Only 1 patient in the nimesulide-treated group could not complete the study because cutaneous erythema occurred with itching; this resolved spontaneously upon treatment withdrawal. It is concluded that nimesulide is as active and safe as paracetamol for the treatment of pyrexia in the elderly.