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Use of antipyretics for preventing febrile seizure recurrence in children: a systematic review and meta-analysis

Abstract

The efficacy of antipyretics for preventing febrile seizure recurrence has been reported by a recent study, and the results might overturn previous evidence. We systematically reviewed the efficacy of antipyretics in the prevention of febrile seizure recurrence in children focused on the timing of its administration. We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases for randomized and quasi-randomized trials and prospective non-randomized studies of aged up to 60 months, diagnosed with febrile seizure, who were treated with antipyretics. Data were extracted from eight studies. Only one study reported that antipyretics prevented the recurrence of febrile seizures within the same fever episode (9.1% in the acetaminophen group vs. 23.5% in the control group, p < 0.01). Four studies found no evidence for the efficacy of antipyretics in preventing febrile seizure recurrence in distant fever episodes (odds ratio, 0.92; 95% confidence interval, 0.57–1.48, for two randomized controlled studies).

Conclusion: This review provides very limited support for the use of antipyretics in preventing febrile seizure recurrence within the same fever episode and no evidence for its use in distant fever episodes. New studies are required to evaluate this topic further and determine whether the effectiveness of antipyretics is based on intervention timing.

What is Known:
• Reviews of prophylactic drug management among febrile seizure children found that antipyretics had no significant benefits.
• Recent data suggest that antipyretics are effective in preventing febrile seizures.
What is New:
• Weak evidence suggests a possible role in preventing febrile seizure recurrence within the same fever episode.
• There is clearly no role for antipyretic prophylaxis in preventing febrile seizures during distant fever episodes.

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Abbreviations

RCT:

Randomized control trials

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Funding

This study was supported by a Grant-in-Aid for the National Center for Child Health and Development. The funding was used for literature search by an information specialist, ordering of full-text papers, and English language editing.

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Authors and Affiliations

Authors

Contributions

Risa Hashimoto developed the concept of the study, designed the study, selected the eligible studies, collected the data, and summarized the data, wrote the initial draft of the manuscript, and revised it. Maiko Suto designed the study, selected the eligible studies, collected the data, summarized the data, and critically reviewed and revised the manuscript. Mariko Tsuji selected the eligible studies, collected the data, summarized the data, and critically reviewed and revised the manuscript. Hatoko Sasaki checked the results of summarized data and critically reviewed and revised the manuscript. Kenji Takehara designed the study and critically reviewed and revised the manuscript. Akira Ishiguro developed the concept of the study and critically reviewed and revised the manuscript. Masaya Kubota developed the concept of the study and critically reviewed and revised the manuscript. We had complete access to the study data that support the publication. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Risa Hashimoto.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was not required for this systematic review.

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Communicated by Gregorio Paolo Milani

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Hashimoto, R., Suto, M., Tsuji, M. et al. Use of antipyretics for preventing febrile seizure recurrence in children: a systematic review and meta-analysis. Eur J Pediatr 180, 987–997 (2021). https://doi.org/10.1007/s00431-020-03845-8

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  • DOI: https://doi.org/10.1007/s00431-020-03845-8

Keywords

  • Antipyretics
  • Antiseizure drugs
  • Febrile seizure
  • Prevention
  • Recurrence
  • Systematic review