Paracetamol and Ibuprofen in the Treatment of Fever and Acute Mild-Moderate Pain in Children: Italian Experts'
Mattia Doria1, Domenico Careddu2, Raffaele Iorio3
1Italian Pediatricians Federation (FIMP), 30015 Chioggia, Italy.
Insights
Pediatric fever and pain management in Italy often shows discrepancies between guidelines and practice. Expert consensus highlights appropriate paracetamol and ibuprofen use to improve care for children and adolescents.
Area of Science:
- Pediatrics
- Pharmacology
- Clinical Practice Guidelines
Background:
- Fever and pain are common pediatric symptoms leading to frequent healthcare consultations.
- Paracetamol and ibuprofen are the primary recommended treatments for fever and mild-moderate pain in Italian children.
- Discrepancies exist between clinical practice and established guidelines for managing these symptoms in both primary care and hospital settings.
Purpose of the Study:
- To analyze the reasons behind the misalignment in fever and pain management practices for children and adolescents in Italy.
- To provide expert consensus statements for the appropriate use of paracetamol and ibuprofen.
- To harmonize therapeutic approaches between community and hospital settings.
Main Methods:
- An Italian board of experts convened to analyze current practices and guidelines.
- An expert opinion consensus process was employed to reach agreement on drug use.
- Focus on clinical scenarios, patient profiles, and drug safety features.
Main Results:
- The consensus process identified appropriate scenarios for paracetamol and ibuprofen use based on patient profiles and drug safety.
- Despite recommendations, critical issues in managing fever and pain persist in pediatric care.
- Expert statements aim to address these persistent challenges.
Conclusions:
- Consensus statements offer a tool to harmonize pediatric fever and pain management across different healthcare settings in Italy.
- These recommendations are particularly crucial for specific patient groups, such as those with dehydration risk or coagulation disorders.
- Promoting educational activities based on these consensus statements can further enhance pediatricians' management of fever and pain.
Abstract:
Fever and pain are challenging symptoms in children and adolescents and are common reasons for consultations in primary care and hospital. Paracetamol and ibuprofen are currently the only recommended drugs for treating fever in Italy, but the therapeutic approaches are discrepant in the different settings. In Italy, paracetamol and ibuprofen are the most prescribed analgesics for acute mild-moderate pain in children; however, their use is often inappropriate in that fever is over-treated and pain is under-treated. An Italian board of experts analyzed the motivations for the misalignment between daily practice and guidelines of fever and acute mild-moderate pain management of the territory and hospitals. The expert opinion consensus process underscored the appropriate use of paracetamol and ibuprofen according to clinical scenarios, patients' profiles, and the safety features of the drugs. Although patients' profiles can indicate different benefits from paracetamol or ibuprofen, critical issues of fever and acute mild-moderate pain management persist in primary care and hospitals. These expert opinion consensus statements can be an across-the-board tool to harmonize the routine practice between the territory and hospitals, especially under special conditions (at-risk for dehydration, coagulation disorder patients, etc.). It can also promote educational activity about fever and acute mild-moderate pain management to enhance the milestones already achieved by Italian pediatricians.
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