This is one of the most important chapters of this book. As it will be shown throughout the chapter, management of fever is more than just administration of antipyretics. Fever is the leading cause for seeking a physician’s attention (about 30% of professional consultations), and antipyretics are prescribed almost routinely to reduce it. Antipyretics are among the most commonly used medications in children. The use of antipyretics to lower body temperature should be used with indications and proper judgement.
Arguments for and against the use of antipyretics are discussed in detail: Current concepts among parents and medical professionals, the fear of febrile seizures are among the factors for the use of antipyretics. The beneficial effects of fever on body immunity and against microorganisms are factors against antipyretic use.
Paracetamol is the best antipyretic available. It is the only available drug for fever and pain in children from birth and younger than 3 months of age. It is the first choice for antipyresis and analgesia, but has no anti-inflammatory property. Unlike ibuprofen, paracetamol can be used in children with dehydration, and with chickenpox ibuprofen cannot be used at this age.
In recent years it has become a common practice to combine the two antipyretics paracetamol and ibuprofen to treat febrile children in hospital and at home. This practice is discouraged. Although there is some evidence that this practice of combining/alternating antipyretics may be more effective at reducing fever for a greater period of time than monotherapy, a recent Cochrane search found no evidence that it improves the child’s comfort or changes the outcome of the underlying disease.
Antipyretics may be indicated as a matter of routine in the following conditions: symptomatic fever with pain, discomfort, delirium and excessive lethargy. Antipyretics serve here to improve the child’s well-being, allowing the child to take fluid and reduce parental anxiety.
Antipyretics Paracetamol Ibuprofen Combining antipyretics Physical treatment Assessing febrile children Management of fever in hospital and at home
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