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Treatment of fever in childhood
1Department of Antimicrobial Therapy and Immunology of Infections, Children Hospital, University of Munich, Germany.
Insights
Routine fever treatment in children is debated. While not always necessary, common antipyretics like acetaminophen and aspirin carry risks, including liver failure and Reye syndrome, questioning their widespread use.
Area of Science:
- Pediatrics
- Pharmacology
- Public Health
Background:
- Routine antipyretic therapy in children is frequently debated.
- Physicians often use antipyretics to alleviate parental anxiety regarding fever.
- Commonly used antipyretics include acetylsalicylic acid (ASA), paracetamol (acetaminophen), and dipyrone (metamizol).
Purpose of the Study:
- To review the current understanding of antipyretic use in children.
- To evaluate the safety profiles of commonly used antipyretic medications.
- To discuss the implications of recent findings on the widespread use of antipyretics.
Main Methods:
- Literature review of clinical trials and epidemiological studies on antipyretics in children.
- Analysis of reported adverse events associated with acetylsalicylic acid, paracetamol, and dipyrone.
- Assessment of the association between antipyretic use and serious health conditions.
Main Results:
- Extensive data exist for paracetamol and ASA, with fewer trials on dipyrone.
- Acetylsalicylic acid (salicylates) has shown a strong association with Reye syndrome.
- Paracetamol is a leading cause of acute hepatic failure.
- Dipyrone has been linked to agranulocytosis.
Conclusions:
- The extensive use of antipyretic drugs in children is increasingly questioned due to significant safety concerns.
- While not contraindicated, the risks associated with common antipyretics necessitate careful consideration.
- Further clinical trials on dipyrone are needed, alongside a re-evaluation of current prescribing practices.
Abstract:
Although the need for routine antipyretic therapy in children has often been questioned, there are no data to contra-indicate this. Not all fevers need to be treated but many physicians do so to relieve parental concern. The most commonly used antipyretic drugs are acetylsalicylic acid (ASA), paracetamol (acetaminophen) and dipyrone (metamizol). Paracetamol and ASA have been extensively evaluated but there are few clinical trials on dipyrone. In the last decade a strong statistical association has been observed between salicylates and Reye syndrome. Paracetamol is the most common cause of acute hepatic failure. Dipyrone has been associated with agranulocytosis. In the light of these findings the extensive use of antipyretics drugs has been seriously questioned.