Clinical Report-Fever and Antipyretic Use in Children

PEDIATRICS (Impact Factor: 5.3). 02/2011; 127(3):580-7. DOI: 10.1542/peds.2010-3852
Source: PubMed

ABSTRACT Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a "normal" temperature. Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child's overall comfort rather than focus on the normalization of body temperature. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized. Current evidence suggests that there is no substantial difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever. There is evidence that combining these 2 products is more effective than the use of a single agent alone; however, there are concerns that combined treatment may be more complicated and contribute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices.

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    • "BSA is independent of diuresis and will not compensate for possible dehydration that some infants with fever may exhibit. However, infants in our study did not exhibit weight loss or signs of dehydration and adequate fluid intake is, often together with antipyretics, a well-established first therapeutic intervention by parents and pediatricians [38]. Nonetheless, in our study both normalization parameters, creatinine and body surface area, and raw data showed significant differences between tetranor-PGEM levels in urine from infants with fever and their age-matched, healthy controls (Fig. 3, Supplementary Table 1). "
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    ABSTRACT: We have investigated the clinical feasibility of the major urinary metabolite of prostaglandin (PG) E2, tetranor-PGEM, as a biomarker of inflammation in infants with fever. We tested two different and clinically relevant sampling methods, using self-adhesive urinary bags or gauze pads, with respect to stability of tetranor-PGEM and ease of sampling from infants. Liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis was used to quantify tetranor-PGEM in urine, and different normalization parameters, i.e., urinary creatinine and body surface area, were investigated. To study inflammation, infants (1 month - 1 year) that were hospitalized with fever of unknown origin at admittance (n=14) were compared to age-matched healthy controls (n=14). Levels of urinary tetranor-PGEM in infants with viral induced fever were increased compared to controls (102.4 ± 56.2 vs. 37.0 ± 21.6 pmol/ml/m2 body surface area, p<0.001). We conclude that urinary tetranor-PGEM is a potential non-invasive biomarker of inflammation in infants.
    Prostaglandins Leukotrienes and Essential Fatty Acids 09/2014; YPLEF1619(6). DOI:10.1016/j.plefa.2014.09.006 · 1.98 Impact Factor
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    • "However, students often find it hard to conceptually distinguish host defenses (e.g., fever) from true pathological defects (e.g., seizures) in disease. For example, while fever was once viewed as pathological, current recommendations advocate against treating fever in children (Sullivan and Farrar 2011), correctly noting that " fever…is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. " Fever is increasingly viewed as an adapted facultative response (Kluger et al. 1996). "
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    ABSTRACT: Medical students have much to gain by understanding how evolutionary principles affect human health and disease. Many theoretical and experimental studies have applied lessons from evolutionary biology to issues of critical importance to medical science. A firm grasp of evolution and natural selection is required to understand why the human body remains vulnerable to many diseases. Although we often integrate evolutionary concepts when we teach medical students and residents, the vast majority of medical students never receive any instruction on evolution. As a result, many trainees lack the tools to understand key advances and miss valuable opportunities for education and research. Here, we outline some of the evolutionary principles that we wished we had learned during our medical training. KeywordsMedical education–Evolution–Natural selection–Phylogeny–Virulence–Host defenses–Tradeoffs–Ultimate causation
    Evolution Education and Outreach 12/2011; 4(4):574-579. DOI:10.1007/s12052-011-0362-1
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    ABSTRACT: To evaluate the evidence surrounding the use of combinations of paracetamol and ibuprofen in the treatment of fever. Systematic narrative review of randomised controlled trials using the UK Economic and Social Research Council guidance on the conduct of narrative synthesis. Inpatient, outpatient and home care. Children with fever. The effect of combination treatments of paracetamol and ibuprofen on fever and comfort, and identification of side effects. Seven studies were identified, six of which provided useful data for the evaluation of the effect of treatment on temperature. Overall these studies showed limited benefit from the combined treatment until around 4 h, after which there was a statistically but only marginally clinically significant benefit. Two studies contained data directly relating to comfort; these suggest a marginal benefit from the combined treatment, but the clinical significance of this was limited. There was no evidence of greater side effects or toxicities associated with the combined treatment. However, it is important to note that these studies were small, short term, and not conducted in the normal setting in which these treatments are given. There is little evidence of any benefit or harm from the combined treatment compared with the use of each drug alone. In the absence of such benefit, there is little to recommend the unnecessary use of polypharmaceutical methods to treat a symptom that does not require treatment, when effective monotherapies exist.
    Archives of Disease in Childhood 08/2011; 96(12):1175-9. DOI:10.1136/archdischild-2011-300424 · 2.91 Impact Factor
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