Consensus on the Use of Mefenamic Acid in Pediatric Practice (MAPP): Perspectives From Indian Pediatricians

Fever and pain are among the most common reasons for pediatric consultations, requiring effective and safe management strategies. Mefenamic acid, a well-established member of the nonsteroidal anti-inflammatory drug (NSAID) class, offers distinct advantages due to its unique pharmacological profile, including preferential cyclooxygenase-2 (COX-2) inhibition, E-type prostanoid (EP) receptor blockade, and nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome inhibition. These properties enable it to address both inflammatory and non-inflammatory fevers, providing comprehensive symptom relief. Despite its proven efficacy, the absence of pediatric-specific guidelines and perceived concerns about safety have limited its routine use in pediatric practice. This consensus paper, developed through a structured modified Delphi process involving 21 expert pediatricians across India, aims to address these gaps. The paper evaluates the safety, efficacy, and clinical applications of mefenamic acid, providing evidence-based best-practice recommendations. Highlights include its superior antipyretic efficacy compared to paracetamol and ibuprofen, with preclinical and limited clinical data suggesting potential antiviral activity, and a possible role in the management of febrile seizures and inflammatory conditions. While mefenamic acid demonstrates a favorable safety profile with appropriate use, further research is necessary to strengthen the evidence on long-term safety and expand its therapeutic scope. This consensus provides a comprehensive framework for optimizing the use of mefenamic acid in pediatric practice, ensuring improved patient outcomes. The long-term safety of mefenamic acid in children is still unclear, due to the limited availability of robust, longitudinal safety data. Future research should prioritize well-powered clinical trials, particularly in children aged six months to five years, using standardized outcome measures and long-term follow-up protocols. Addressing these evidence gaps is important to inform safe and effective use in pediatric practice.