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Enduring large use of acetaminophen suppositories for fever management in children: a national survey of French parents and healthcare professionals’ practices

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Abstract

The pharmacological specificities of the rectal formulation of acetaminophen led to a debate on its appropriateness for managing fever in children, but few data are available on the formulation’s current use and determinants of use. In a national cross-sectional study between 2007 and 2008, healthcare professionals were asked to include five consecutive patients with acute fever. Among the 6255 children (mean age 4.0 years ± 2.8 SD) who received acetaminophen given by parents or prescribed/recommended by healthcare professionals, determinants of suppository use were studied by multilevel models. A suppository was given by 27 % of parents and prescribed/recommended by 19 % of healthcare professionals, by 24 and 16 %, respectively, for children 2 to 5 years old, and by 13 and 8 %, respectively, for those 6 to 12 years old. Among children who received suppositories from parents and healthcare professionals, 83 and 84 %, respectively, did not vomit. Suppository use was independently associated with several patient- and healthcare professional-level characteristics: young age of children, presence of vomiting, or lack of diarrhea.

Conclusion: We report an enduring large use of suppositories in France for the symptomatic management of fever in children, including in non-vomiting and/or older children. The rational for such use should be questioned.

What is Known:

• The pharmacological specificities of the rectal formulation of acetaminophen have led to a debate on its appropriateness for managing fever in children. Few data are available on the formulation’s current use and determinants of the use.

What is New:

• In a national cross-sectional study, we observed a large use of suppositories in France for symptomatic management of fever in children. Suppositories were frequently used for the youngest children but also for older and/or non-vomiting children.

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Abbreviations

aOR:

adjusted odds ratio

OR:

odds ratio

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Author’s contributions

NB performed the analyses, drafted the manuscript, and approved the final manuscript as submitted. GP conceptualized and designed the study, designed the data collection instruments, critically reviewed the manuscript, and approved the final manuscript as submitted. BK critically reviewed the statistical analyses and the manuscript, and approved the final manuscript as submitted. EFC conceptualized and designed the study, designed the data collection instruments, critically reviewed the manuscript, and approved the final manuscript as submitted. MC conceptualized and designed the study, designed the data collection instruments, supervised the data analyses, drafted the manuscript, and approved the final manuscript as submitted.

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Authors and Affiliations

  1. Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, 53 avenue de l’Observatoire, 75014, Paris, France

    Nathalie Bertille, Babak Khoshnood & Martin Chalumeau

  2. Sorbonne Universités, UPMC Univ Paris 06, IFD, Paris, France

    Nathalie Bertille

  3. Department of General Pediatrics, Hôpital Necker-Enfants malades, Assistance publique – Hôpitaux de Paris (AP-HP), Paris-Descartes University, Paris, France

    Nathalie Bertille & Martin Chalumeau

  4. Pain center, Hôpital Bicêtre, AP-HP, Kremlin-Bicêtre, France

    Elisabeth Fournier-Charrière

  5. Clinical Pharmacology, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris-Descartes University, Paris, France

    Gérard Pons

  6. Inserm U663 Pediatric epilepsies and brain plasticity, Paris, France

    Gérard Pons

Authors
  1. Nathalie Bertille
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  2. Elisabeth Fournier-Charrière
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  3. Gérard Pons
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  4. Babak Khoshnood
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  5. Martin Chalumeau
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Corresponding author

Correspondence to Nathalie Bertille.

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Financial disclosure

NB is supported by an educational grant from Laboratoires Guigoz - Société Française de Pédiatrie - Groupe de Pédiatrie Générale - Groupe de Recherches Epidémiologiques en Pédiatrie and by Sorbonne Universités, UPMC Univ Paris 06 (educational grant of Ecole Doctorale 393). The work was also funded by Sanofi Aventis. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interest

The work was funded by Sanofi Aventis, a pharmaceutical group that markets acetaminophen and ibuprofen. NB is supported by an educational grant from Laboratoires Guigoz - Société Française de Pédiatrie - Groupe de Pédiatrie Générale - Groupe de Recherches Epidémiologiques en Pédiatrie and by Sorbonne Universités, UPMC Univ Paris 06 (educational grant of Ecole Doctorale 393). EFC and GP received honoraria from Sanofi Aventis. MC belongs to the Assistance Publique-Hôpitaux de Paris, which has received research grants from Sanofi Aventis. We have no patents, products in development, or marketed products to declare. The other authors have no conflicts of interest to disclose.

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Communicated by Mario Bianchetti

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Bertille, N., Fournier-Charrière, E., Pons, G. et al. Enduring large use of acetaminophen suppositories for fever management in children: a national survey of French parents and healthcare professionals’ practices. Eur J Pediatr 175, 987–992 (2016). https://doi.org/10.1007/s00431-016-2732-8

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  • DOI: https://doi.org/10.1007/s00431-016-2732-8

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