What’s the best fever reducer for kids?

Tylenol vs Motrin: What’s the best fever reducer for kids?

When our children have fever or pain, we naturally want to make them feel better. Tender loving care can go a long way, but sometimes we need a little help from medications. When considering when to give medications for fever or pain and also what to give, the first thing to do is realize why we’re using the medication.

Pain

Pain is pretty self-explanatory – nobody wants their child to be in pain. Pain is not only upsetting, but it also can increase the heart rate, breathing and blood pressure (although not usually to dangerous levels) and make a child cranky or withdrawn.

One of our key jobs as parents and caregivers is to reduce suffering by trying to minimize or prevent pain. Acetaminophen (such as the Tylenol™ brand) and ibuprofen (such as Motrin™ or Advil™) are our main tools to do that.

Both are great medications for fever and pain, but ibuprofen has an added benefit of fighting inflammation, which acetaminophen does not. For this reason, ibuprofen is sometimes preferred for pain from injuries or illnesses involving inflammation.

Fever

Fever is one of the most common reasons caregivers seek medical evaluation for their children. There is much apprehension about fever: some people are afraid for their children when they have fever, having heard stories about fever causing brain damage and convulsions or even death. Couple that with the fact that children often look and act much sicker when they have fever, and it adds up to a lot of anxiety.

Caregivers often turn to acetaminophen or ibuprofen, and sometimes both, in an effort to make the fever go away. There’s a lot of confusion about which medicine to give, how much to give and when to give it.

The good news is most stories about the dangers of fever are absolutely false! Fever from infection rarely goes above 106 F. The body temperature has to go above about 107 F before there is any damage to the brain or body.

There is such a thing as febrile seizures, but they are limited to children between the ages of 6 months and 5 years. When they occur, they are usually very brief and do not cause complications. They are completely unpredictable and do not occur because the temperature goes above a certain level. They’re far scarier than they are dangerous.

A fever that doesn’t go down all the way with proper doses of fever medication or one that comes back before the next dose is due is neither an indicator of infection nor of the seriousness of the illness. The fact that you can’t completely control the fever is not something to worry about, as it means nothing about the infection that’s causing the fever. The fever will go away when the worst of the infection goes away.

The real reason to treat fever is to make your child feel better. Fever itself, regardless of the source of the infection, will increase the heart rate and breathing rate; make your child sleepy, cranky or clingy; and decrease their appetite. If you can get the fever down even a degree or two, your child will likely feel better, start eating and drinking better, and look much more like themselves. Then you’ll feel better too!

Fever Control

Both acetaminophen and ibuprofen are excellent medications for fever control.

We tend to limit ibuprofen to children older than six months. Children with kidney disease, bleeding problems or a few other chronic illnesses may not be able to take ibuprofen. If your child has a chronic disease, check with your primary care provider to see if he or she can safely take ibuprofen.

A few studies have suggested ibuprofen may be better than acetaminophen in helping to treat fevers over 102 – 103 F, while acetaminophen may be better for children who are also having stomach pain or upset, because ibuprofen can sometimes irritate the stomach.  

Some children consistently seem to respond better to one medication than the other. Each individual illness may also respond better to a particular medication. If you get a feeling that one medication is working better than the other, use that medication.

Many medical providers recommend alternating acetaminophen and ibuprofen for better fever control. Studies suggest there may be a slight improvement in fever control when using both medications; however, there is also an increased chance the child will accidentally be given an overdose of one or both medicines, especially if more than one person is giving the child medication.

With this possible safety concern about accidental overdose, there’s little benefit in using the medicines on an alternating schedule.  If you choose to alternate acetaminophen and ibuprofen, alternate them every 4 hours. For example, give acetaminophen at noon, ibuprofen at 4pm, acetaminophen at 8pm, and so on. If more than one person will be giving medications, keeping a written schedule may help reduce dosing errors.

There is absolutely no evidence that giving acetaminophen and ibuprofen at the same time helps to control the fever. This practice can also lead to significant medication overdoses thus is not safe.

Dosage

Oral dosing recommendations on the packages of medications are most often given in weight or age ranges. This can lead to under-dosing or slight over-dosing. It’s best to get a dosing chart or recommendations from your medical care provider so you can dose your child based on their current weight.

We recommend ibuprofen to be given at 10mg per kilogram of weight (about 10mg for every 2 pounds) every 6-8 hours or acetaminophen at 15mg per kilogram of weight every 4-6 hours.

Acetaminophen can also be given as a rectal suppository, but they are available in a limited selection of doses. Suppositories should not be split to modify the dose because the medication may not be suspended equally throughout the suppository, so one portion may have more medication than another. This limits the usefulness of the suppositories. It is not true that suppositories work better or faster than oral medication. Ibuprofen is not available in suppository form in the U.S.

Conclusion

To sum it all up, whether they have fever or pain, we use acetaminophen and ibuprofen to make our children feel better. With a few exceptions, both medications are safe to use when given in appropriate doses and with appropriate timing.

Ibuprofen may be better than acetaminophen for injuries or illnesses that also involve pain and inflammation or for higher fevers.

There is no need to alternate the two medications for fever. Keep it simple and use which ever medication seems to work better. Consult your primary care or urgent care provider to learn the safest and most effective doses to meet your child’s needs.

Lou Romig, MD, FAAP, FACEP, Medical Director

After Hours Pediatrics Urgent Care

Click here to read more Doctor’s Orders articles

Ibuprofen Alone and in Combination With Acetaminophen for Treatment of Fever – Full Text View

Despite a lack of evidence to support their fears, a majority of parents, pediatricians, and pediatric nurses believe that fever can be dangerous to a child. This “fever phobia” has caused a majority of caregivers to aggressively treat fever with antipyretics such as ibuprofen and acetaminophen, often in combination. Although there is scant data to support the use of these medications together for fever control and none using alternating regimens, it was recently reported that 50% of pediatricians and 70% of pediatricians with less than 5 years of experience advise parents to alternate acetaminophen and ibuprofen as an attempt to achieve maximal antipyresis. While a combination of aspirin (no longer used for antipyresis in children) and acetaminophen has been shown to be superior to either agent alone for fever reduction, these data cannot be extrapolated to the pairing of ibuprofen and acetaminophen.

There is evidence that combinations of acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are more effective for the treatment of pain and can reduce opioid use when compared with a single agent. Improved activity and alertness in children have been reported after antipyretic administration.

It is believed that acetaminophen and ibuprofen may be safely used together because the two medications have significantly different pathways of metabolism that are not affected by each other, and have been used abroad in combination form for over a decade. Both acetaminophen and ibuprofen have been shown to be safe when given individually or together in recommended doses for short term use. There are no reports of adverse effects from combination therapy with standard doses.

In addition, while it now appears that fever itself is probably a protective physiologic response, under different circumstances it has the potential to be harmful. Fever increases the metabolic rate approximately 10% for every 1 degree C rise in body temperature. The myocardial depression,orthostatic dysfunction, and increases in oxygen consumption, respiratory minute volume, and respiratory quotient that occur may not be tolerated by all patients including some children.

Because of the ubiquitous nature of the problem, childhood fever, this study has the potential to immediately impact the way clinicians and parents treat children with fever. If the combination regimens are not shown to be superior, it could limit improper medication administration and overdose. If it is superior, the combination of medications may improve other symptoms associated with fever such as discomfort. Either way, it will fill the gap that exists in the evidence-based approach to the management of childhood fever and immediately impact current practice.

Combining Tylenol & Advil to Reduce Fever

February 22, 2021

When deciding what medication to use for pain management or fever reduction, many people turn to two of the best over-the-counter options: Tylenol (acetaminophen) and Advil or Motrin (ibuprofen). Both are available in name-brand or store-brand varieties, and the later work equally well.

Often, those looking for pain relief assume they must choose one medication or the other when, in fact, it is possible to use both medications together as each is processed differently by the body—acetaminophen is processed through the liver while ibuprofen clears through the kidneys. Additionally, studies have indicated that, when combined correctly, acetaminophen and ibuprofen provide greater relief than when used independently of one another.

For Adults and children over age 12

Researchers have recently investigated just how powerful the combination of acetaminophen and ibuprofen are in managing pain in adults. Studies indicate that, when combined, the two offer an equal  level of pain relief as opioid narcotics.

For children over the age of 12 and adults, both medications may be taken together at the same time. It is important to note the recommended dosage limits for adults and children over the age of 12:

• 3,000 mg per day for acetaminophen
• 1,200 mg per day for ibuprofen

In March of 2020, the FDA approved the first over-the-counter acetaminophen and ibuprofen combination drug in the U.S. Labeled Advil Dual Action, the medication is currently available at drugstores and grocery markets and contains 125mg of ibuprofen and 250mg of acetaminophen per tablet. Always read packaging labels and talk your doctor before starting a new medication.

The release of this drug is promising news as doctors look for alternatives to narcotics while the nation continues to battle the opioid epidemic.

For Fever Reduction in Children Under 12

When children experience fever, a caregiver’s first reaction is to try to eliminate it. While we want to offer medication that makes children more comfortable, it is important to remember that fever serves an important role in fighting infection. The presence of fever is a positive indication that the body’s immune response is working properly.

However, to provide comfort, choose either a children’s acetaminophen or ibuprofen and follow the dose directions on the back of the bottle. If one medication does not seem to work sufficiently to reduce fever or pain in children age 12 and under, the key is to alternate between acetaminophen and ibuprofen: administer one medication at 10 a.m., 2 p.m., and 6 p.m., and the other at 12 p.m., 4 p.m., and 8 p.m.

It is important to read the back of the package for dosing recommendations, and always check with your pediatrician before starting a new medication.

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Home Treatment and When to See a Doctor

Fever is an increase in the body’s temperature above the normal range. Body temperature can vary throughout the day, and may be different from one person to the next. It is hard to give an exact temperature for a fever, but most doctors agree that a temperature over 101° F is a fever.

The body’s temperature is controlled by a part of the brain that acts as a thermostat. Fevers are caused when the thermostat is set higher than normal. This is usually in response to an infection from a virus or bacteria. It can also happen with heat exhaustion, extreme sunburn and other medical conditions.

Fevers lower than 101° F do not need to be treated unless your child is uncomfortable or has a history of febrile seizures. Even higher temperatures are not typically dangerous unless there is a history of seizures or long-term illness. More important than the temperature is your child’s behavior. If your child is eating and sleeping well, is playful some of the time, and is comfortable, you may wait to see if the fever improves without treatment.

Home Treatment

• Dress lightly. While your child is sleeping cover him with a sheet or light blanket.

• Try to have your child drink extra fluids.

• Your child can drink milk as normal, but solid food may be hard for him to digest. Do not worry if your child does not want to eat while he has a fever.

• It is okay to let your child up out of bed, but he should play quietly and rest.

• Medicines such as ibuprofen or acetaminophen can be used for a fever higher than 101° F or if your child is uncomfortable. These medications are safe, effective ways to lower the fever. Acetaminophen (Tylenol®) may be used in all children over 2 months. Ibuprofen (Advil®, Motrin®) may be used in children over 6 months. Follow the package directions or talk to your doctor or pharmacist for dosing instructions. Do NOT give aspirin to children. Aspirin has been linked to a disease called Reye’s syndrome, which can be fatal.

Caution: Medicines that reduce fever come in different strengths. Make sure you are using the correct strength before giving it to your child.

When to Call the Doctor

Call your child’s doctor immediately if your child has a fever and:

• Is younger than 2 months of age and has a rectal temperature of 100. 4° F or higher.

• Looks very ill, is very fussy, or is hard to wake up.

• Has been in an extremely hot place, such as an overheated car.

• Has a stiff neck, severe headache, severe sore throat, severe stomachache, unexplained rash, or repeated vomiting and diarrhea.

• Has a condition that lowers immunity, such as sickle cell disease, cancer, or frequent oral steroid use.

• Has had a seizure.

• Shows signs of dehydration – dry or sticky mouth, sunken eyes, not urinating.

Sponge Baths

Sponge baths may be used along with medicines to treat a fever over 104° F. Or sponge baths can be used to lower the temperature if your child is vomiting and cannot keep medicine down. Sponge baths usually start to work within 15 minutes.

To give a sponge bath for a child that can be put in the bathtub:

• Place your child in a bathtub with lukewarm (85°- 90° F) water. Sponge water over his skin. Evaporation will help cool the skin and lower the fever.

• If your child cannot sit in the bathtub, lay lukewarm wet washcloths on his stomach, groin, under the arms and behind the neck.

• Do not use cold water to sponge your child. This is uncomfortable and could cause shivering. This can increase the temperature.

• Do not add alcohol to the water. Alcohol can be absorbed into the skin or inhaled. This can cause serious problems, such as coma.

• If your child struggles with the sponge bath, let him play in the water. If he still is upset, it is better to stop, even if the temperature is still high.

To give a sponge bath for a child that cannot be put in the bathtub:

• Dip washcloths in warm – not hot, water and wring them out. Place washcloths on the child’s stomach, groin, under the arms, and behind the neck.

• Change the washcloths as soon as they start to cool. The cool washcloths should be replaced with warm washcloths.

• After 20 minutes, remove the washcloths and dry your child. Cover your child with a light blanket.

• Wait 30 minutes and take your child’s temperature.

• If the temperature is above 103° F or is going higher, repeat the sponging.

Fever (PDF)

HH-I-105 10/75 Revised 9/10 Copyright 1975-2010, Nationwide Children’s Hospital

Fever in child age birth to 3 years old | child with temperature

What is a fever?
Fever is a common symptom of illness.  We define a fever as a temperature of 100.5 F (38 C) or higher.  The height of a fever does not determine the cause of the illness but can be an important clue. Fever is just one indicator of how a child is doing, and we always encourage parents to look at the overall behavior of their child considering such things as fussiness, clinging, work of breathing, interest in feeding, consolability etc.  If you child is ill and you are worried, we want to hear from you or see you in person.

How do I take my child’s temperature?
In general we encourage at home use of digital thermometers and using an armpit or oral temperature. Rectal temperatures are more accurate but more difficult to take.  Rectal temperatures are a bit easier with infants and the precise temperature is more important with infants. Temperature taken in the armpit is usually 1 degree lower than an oral temperature. We will use a temperature obtained in our office for clinical decision making about how much testing is needed to diagnose a cause, and will rely on home temperatures and parental perception of severity of illness to guide us on whether or not an appointment is needed.

Do I need to bring my child to the office?
Any infant less than 3 months of age with a fever should be evaluated in our office.

Infants aged 3 months to 3 years with a fever who appear ill or are not feeding well should be seen, and even if appearing well should be seen in our office if their fever lasts more than 3 days or is over 102 F (38.9 C).

Additionally we would like to see children of any age with a fever over 104 F (40 C).  Fever with a new rash, fever lasting more than 7 days and fever in children with other chronic medical problems are all reasons for us to evaluate a child in person.

Are there medications for fever?
Acetaminophen (Tylenol) and Ibuprofen (Motrin, Advil) can lower fever by 2-3 degrees. If children appear well and are behaving normally it is not always necessary to treat their fever. When infants and children have a fever they do often appear ill and fussy and treating their fever can relieve pain, achiness and malaise and sometimes improve feeding behavior.

How much medication should I give?
Dosing is based on weight, but manufacturers are reluctant to provide dosing for infants.  We have provided the age and weight based dosing below for the use of our established patients as a reference for use in consultation with us. Please remember we want to see any infant younger than 3 months with a fever, and any infant or child who is so ill their parents are worried in person at our office.

Mistakes in dosing can occur when the concentration and measurement of medication is not properly confirmed. Mistakes in the timing between doses can lead to overdose as well. Acetaminophen and Ibuprofen can be administered together or alternated on an every 3 to 4 hour schedule.  Alternating doses is very effective but  increases the risk of accidentally overdosing by giving the same medication twice in a row.

For Acetaminophen (Tylenol) labeled 160 mg/5 ml and Ibuprofen (Motrin/Advil) labeled 100 mg/5 ml

5-11 pounds……….. 0-3 months………… 1.25 ml (1/4 tsp) every 6 hours

12-17 pounds……… 4-11 months……….. 2.5 ml (1/2 tsp) every 6 hours

18-23 pounds……… 12-23 months……… 3.75 ml (3/4 tsp) every 6 hours

24-35 pounds……… 24-36 months…….. 5 ml (1 tsp) every 6 hours

There is an older version of Acetaminophen with a concentration of 80 mg/0.8 ml.    This is over 3 x as concentrated, so the dose volumes are much lower. This is the one marketed as infant drops, and is no longer being produced.

5-11 pounds……….. 0-3 months………… 0.4 ml every 6 hours

12-17 pounds……… 4-11 months………. 0.8 ml every 6 hours

18-23 pounds…….. 12-23 months……… 1.2 ml every 6 hours

24-35 pounds……… 24-36 months…….. 1.6 ml every 6 hours

Taking care of an ill infant or toddler is a difficult responsibility and we are always here to help!

Fever and Pain Relief for Colds and Flu

If you’re looking for relief from the symptoms of a cold, fever, or the flu, you’ll find many over-the-counter (OTC) options at your local pharmacy.

The pain and fever-reducing ingredients often found in these medicines — acetaminophen, ibuprofen, naproxen sodium, and aspirin — are safe for most adults if taken correctly. But in the throes of fever or the flu, you may not think as clearly about safety.

To be prepared, read this primer on OTC pain relievers, so when illness strikes, you’ll know how they work to reduce fever, aches, and pains and how to use them safely.

Pain Relief Basics: NSAIDs and Acetaminophen

Two common groups of pain relievers are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Most OTC pain relief drugs contain one or the other.

These medications don’t make illnesses go away, but they can relieve some symptoms so you suffer less while the cold, flu, or fever works its way through your system.

NSAIDs. This group of drugs relieves pain and fever by tamping down on the substances in your body that cause the feeling of pain, and they help control body temperature.

Continued

Drugs in the NSAID category include:

• Ibuprofen, the active ingredient in Advil and Motrin
• Aspirin, found in Bayer or St. Joseph
• Naproxen sodium, found in Aleve

Acetaminophen. This is an active ingredient in Tylenol and many other prescription and non-prescription medications. Acetaminophen seems to work on the parts of the brain that perceive pain and control body temperature.

The Risks of Taking NSAIDs for Pain Relief

NSAIDs are safe for most people when taken at the right dose for a short period. However, they can increase risk for serious stomach bleeding. NSAIDs may also increase the chance for heart attack and stroke.

Ask a doctor before using NSAIDS if:

Combining NSAIDs with more than two to three alcoholic drinks a day for women or three to four for men increases the risk for stomach bleeding. Taking NSAIDs along with blood-thinning medications can also increase the risk for bleeding, including serious stomach bleeding. Talk to your doctor if you drink alcohol or take and blood-thinning medicines before using an NSAID. Others factors that increase risk for stomach bleeding include:

• Having a previous history of stomach bleeding
• Being over age 60
• Taking steroid medications, or other NSAID medications

Risks of Using Acetaminophen for Pain Relief

The most serious risk from acetaminophen is liver damage. Ignoring the dose recommended on the label can put you at risk of severe liver damage.

People who are at greater risk for liver damage from acetaminophen include people with liver disease and men who drink three or more alcoholic drinks a day (or two a day or more drinks for women).

Talk to your doctor or pharmacist if you also take the blood thinner warfarin (Coumadin), because it may increase the risk of bleeding.

It is important to read the package labeling carefully and not exceed the maximum daily dosage. Because many other OTC and prescription products contain acetaminophen as an active ingredient, make sure to look at the list of active ingredients in other medicines you are taking in order to avoid overdosing.

Because the signs and symptoms of liver damage from acetaminophen may not be immediately noticeable, if you think you may have taken too much, call 911 or poison control (800-222-1222) immediately.

The Risks of Combination Medicines

OTC pain relievers are often used with other ingredients in prescription and non-prescription medications, including some for arthritis, menstrual symptoms, allergies, and sleeplessness. To avoid an overdose, it’s important not to take two medicines that contain the same pain reliever.

Mixing medicines that contain different pain relievers can also cause problems and should not be done without talking to a doctor.

Safe Pain Relief for Adults

Because of the risks of overdosing on a pain medication, it’s important to keep track of how much you take and how long you take it.

Follow these other drug safety tips for using OTC pain relievers:

• Read and follow the label. It should clearly state whether a medicine contains acetaminophen or NSAIDs, the risks of the active ingredient, the highest dose you can take safely, and how long you can take it.
• Wait until you need it. Leave acetaminophen and NSAIDs on the shelf until you really need them. Limiting your intake automatically reduces your risk.
• Set a cut-off date. Before taking an NSAID, set a date to stop, based on the label’s instructions for how long you should take it before seeing a doctor.
• Don’t mix medicine with alcohol. If you drink alcohol, talk with your doctor before taking NSAIDs or acetaminophen.

Safe Pain Relief for Children

Drugs work differently in children than they do in adults. Take extra care when giving your child acetaminophen or ibuprofen and only use those products labeled specifically for your child’s age group. Adult medicines and doses are too strong for most kids and should not be given to children.

Beyond not giving aspirin to children and teens (ages 18 and under) due to the risk of Reye’s syndrome, follow these safety measures:

• The FDA recommends that parents not give any cough and cold medicine to children under age 2. The FDA supports the voluntary label change of drug makers to state “do not use in children under 4” for OTC cough and cold medicines.
• Talk to your pediatrician about safe OTC options for your child.
• When giving your child liquid medicine, make sure to use the appropriate measuring tool that came with the medication and not a spoon used for eating or cooking.
• There’s no need to expose your child to drugs they don’t need. Select a medicine that treats only the symptoms your child has.
• Keep all medicine out of children’s reach.

Acetaminophen or an NSAID: Which Is Best?

For some people, acetaminophen is the best way to reduce certain cold and flu symptoms. For others, ibuprofen does the trick. For many, both are equally effective.

How do you know which to take? Talk to your doctor or pharmacist about the other medicines you are taking and your medical history, such as problems with your heart, kidneys, stomach, or liver, or if you take anti-clotting medication or medication for high blood pressure.

Ibuprofen and COVID-19 symptoms – here’s what you need to know

There’s been some confusion recently on whether we should or shouldn’t take ibuprofen to treat symptoms of COVID-19 – especially after the World Health Organization (WHO) changed its stance. After initially recommending people avoid taking ibuprofen to treat symptoms of the new coronavirus disease, as of March 19 the WHO now does not recommend avoiding ibuprofen to treat COVID-19 symptoms.

The confusion began after France’s Minister of Solidarity and Health Oliver Véran announced on Twitter that taking anti-inflammatory drugs (such as ibuprofen or cortisone) could be a factor in worsening a COVID-19 infection. He recommended that paracetamol should be taken instead to treat the associated fever.

At the moment, the NHS only recommends taking paracetamol for COVID-19 symptoms, even though it admits there is no strong evidence showing ibuprofen worsens symptoms. The BMJ also states that ibuprofen should be avoided when managing COVID-19 symptoms.

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs, including ibuprofen, normally have three main uses: they help with inflammation, pain, and fever. People might also take them for inflammatory conditions such as arthritis and for pain. However, paracetamol can also help treat pain and fever.

Fever is a higher than normal body temperature, and is one of the signs of COVID-19, along with a persistent cough and shortness of breath. The body develops a fever as a defence mechanism, where the immune system produces a chain of molecules that tell the brain to make and keep more heat inside to fight the infection.

While getting fever during an infection is part of the body’s defence mechanism, a serious rise in body temperature can be fatal and should be treated. Having fever is also uncomfortable because it often comes with shivering, headaches, nausea and stomach upsets. Taking an anti-inflammatory like ibuprofen or paracetamol will bring down a high temperature by lowering some of the fever molecules. However, doctors who compared the two in 2013 suggested taking paracetamol over ibuprofen for normal chest infections because they found a small number of people’s illness got worse with ibuprofen.

Cause for concern?

Some of the reasons that there’s a concern taking ibuprofen will make COVID-19 symptoms worse comes from previous studies that have shown people with other serious chest infections (such as pneumonia) experienced worse symptoms and prolonged illness after taking an NSAID, including ibuprofen.

But it’s difficult to say if taking ibuprofen in these instances directly causes worse symptoms and prolonged illness, or if it’s because taking ibuprofen or other anti-inflammatories help manage pain, which may hide how serious the illness is and could stop people from asking for help earlier – delaying treatment. Or, it might be to do with ibuprofen’s anti-inflammatory effects. One theory is that anti-inflammatory medicines can interfere with some of the body’s immune response, although this is not proven for ibuprofen.

However, two French studies warn doctors and pharmacists not to give NSAIDs when they see signs of chest infections, and that NSAIDs shouldn’t be given when children are infected with viruses. There’s no agreement on why ibuprofen could make chest infections worse, but both studies reported worse outcomes in patients who had taken a NSAID to treat their condition.

A recent letter to The Lancet suggested that ibuprofen’s harm in COVID-19 is to do with its effect on an enzyme in the body called angiotensin-converting enzyme 2 (ACE2) – though this has yet to be proven. This caused additional worries for patients taking angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for existing heart conditions. Several leading organisations have rightly warned patients not to stop taking their regular medicines in light of unconfirmed theories.

Read more:
COVID-19 Q&A: should I be worried if I take ACE inhibitor drugs for high blood pressure?

Because novel coronavirus is a new type of virus, there is currently no evidence proving that taking ibuprofen will be harmful or make COVID-19 symptoms worse. Research in this area is developing fast, but with so much misinformation about COVID-19 and ibuprofen use, the cautious approach is to avoid ibuprofen with COVID-19 if at all possible – especially for those with pre-existing health conditions. Anyone who thinks they might have COVID-19 can consider using paracetamol instead of ibuprofen for managing their fever, unless they’re told otherwise by their doctor or pharmacist.

In the meantime, the UK’s Committee of Human Medicines and the National Institute for Health and Care Excellence (NICE) have been asked to review all the evidence to understand ibuprofen’s impact on COVID-19 symptoms. Naturally, people already prescribed an anti-inflammatory drug for a health condition should ask their doctor’s opinion and not just stop their medication.

Paracetamol can also treat fever, as well as aches and pains.
Maderla/ Shutterstock

It’s worth noting, however, that ibuprofen and NSAIDs can trigger stomach ulcers and indigestion and might not be suitable for some people with heart disease, kidney and liver problems, and asthma, as well as people over 65, and those who drink more alcohol. These drugs should not be used in people with very high blood pressure, and women trying to get pregnant or already pregnant.

Paracetamol, which can also treat pain and fever, may be preferred. Though it takes up to an hour to work, it’s safe to use for women who are pregnant or breastfeeding, and can be taken with or without food. Some people need to take extra care with paracetamol and should speak with their doctor or pharmacist first, for example if they have liver or kidney problems.

The usual dose of paracetamol for adults is one or two 500 milligram tablets up to four times in 24 hours, with at least four hours in between doses. Most people use a syrup to give paracetamol to children. How much to give depends on your child’s age, but again paracetamol should only be given up to four times in 24 hours, with at least four hours between doses.

Pharmacies have been running short of paracetamol and some shops have been rationing sales. For those exhibiting symptoms, a box of 32 tablets should last for at least four days. At this time of crisis, it’s important people make sure they’re not stockpiling medicines unnecessarily and depriving others who are equally in need of paracetamol and other vital drugs.

90,000 Sequential or combined use of antipyretics in the treatment of fever in children

When children have infectious diseases, they often have a fever. Fever for common viral illnesses such as colds, coughs, sore throats, and gastrointestinal conditions usually lasts several days and is accompanied by poor health and anxiety for children, their parents, and other caregivers.

Paracetamol (also known as acetaminophen) and ibuprofen reduce fever and relieve symptoms in children.This review assessed whether the combination or sequential use of the two drugs is more effective than paracetamol alone or ibuprofen alone.

In September 2013, we found six studies involving 915 children evaluating the combined (combined) or alternating (sequential) use of paracetamol and ibuprofen for the treatment of fever in children.

Compared to taking ibuprofen or paracetamol alone, taking these drugs together is likely to be more effective in lowering body temperature within the first four hours after taking the drugs ( moderate quality evidence ).However, only one trial evaluated the effect of combination treatment on reducing discomfort or anxiety and found no difference compared to ibuprofen alone or paracetamol alone.

In practice, carers are often advised to first give one medication (paracetamol or ibuprofen) and then, if the child continues to have a fever, give the next dose of an alternative medication (medication). Using an alternative treatment in this way (consistently) may be more effective in reducing body temperature in the first three hours after the second dose ( low-quality evidence ) and also in reducing the child’s discomfort ( low-quality evidence )

Only one small trial compared sequential versus combination therapy and found no benefit to either of the two treatments ( very low quality evidence ).

Relevance of the use of NSAIDs in the treatment of fever in children | Mubarakshina O.A.

Fever is the leading symptom in infectious, and primarily in respiratory viral diseases in children. The starting point of its development is the impact of exogenous pyrogens of a viral or bacterial nature. They stimulate the secretion of endogenous pyrogens (interleukins, tumor necrosis factor, interferons).

The main triggering factor of fever is interleukin-1 (IL-1).Through intermediate links in the hypothalamus, it contributes to excess heat generation, delayed heat transfer and the onset of hyperthermia. Under normal conditions, IL-1 does not penetrate the blood-brain barrier. However, in the presence of inflammation, IL-1 reaches the preoptic region of the anterior part of the hypothalamus and interacts with the receptors of the neurons of the thermoregulatory center. This activates the enzyme cyclooxygenase (COX), which leads to an increase in the synthesis of prostaglandins and an increase in the intracellular level of cyclic adenosine-3,5-monophosphate (cAMP).
An increase in the concentration of cAMP promotes the accumulation of calcium ions inside cells and the restructuring of the activity of the centers of heat production and heat transfer. As a result, a new level of temperature homeostasis is established at a higher point: heat production increases and heat transfer decreases. In addition, prostaglandins formed in the affected tissues are important mediators of the inflammatory response and are involved in the pathogenesis of all signs of inflammation (pain, swelling and fever).
The mechanisms of the development of fever determine the fact that over the past years, the drugs of choice with an increase in body temperature and other signs of inflammation (pain syndrome, etc.)) are non-steroidal anti-inflammatory drugs (NSAIDs). By blocking COX, they inhibit the biosynthesis of prostaglandins, which, along with thromboxane and leukotrienes, are included in the group of oxygenation products of polyunsaturated long-chain fatty acids known as eicosanoids.
NSAIDs used in pediatric practice should have the most favorable efficacy / safety ratio. Moreover, not all drugs popular in our country today meet modern requirements.
In the past, salicylic acid preparations and pyrazolone derivatives have been used for a long time. However, at present, the Russian National Pharmacological Committee and the Union of Pediatricians of Russia do not recommend the use of some previously widely used drugs in pediatric practice. Thus, the use of acetylsalicylic acid is not recommended for the treatment of fever, especially of viral etiology, in children under 15 years of age.
This prohibition is associated with the pronounced toxic effects of acetylsalicylic acid and the possibility of developing Reye’s syndrome, characterized by toxic encephalopathy and fatty degeneration of internal organs, mainly the liver and brain.The widespread use of metamizole sodium is also limited due to the high frequency of side effects.
The main drugs that meet the criteria for efficacy and safety are acetaminophen (paracetamol) and ibuprofen (Nurofen for children). It is these drugs that should be the means of choice for fever in children in accordance with the official recommendations of the WHO and national pediatric programs.
Ibuprofen is a propionic acid derivative. It was developed in 1962.and registered in England in 1968 as a physician-prescribed anti-inflammatory agent for the treatment of rheumatoid arthritis. It was only later that ibuprofen was used as an over-the-counter pain reliever and antipyretic drug.
The experience of using ibuprofen has shown high efficiency, good tolerance and caused less pronounced side effects from the gastrointestinal tract than acetylsalicylic acid. Further clinical studies have confirmed these properties. It was found that the pharmacological effects of ibuprofen are primarily due to its antiprostaglandin action due to the indiscriminate blockade of COX-1 and COX-2.
In the 1980s, ibuprofen was introduced into pediatric practice in a number of countries, including the United States and Great Britain. Currently, the drug is registered and used in many countries under the patented name “Nurofen”. Children use a suspension of ibuprofen (20 mg / ml) – “Nurofen for Children”, sugar-free, approved for over-the-counter use in children from the age of 3 months.
Pharmacokinetics. When taken orally, ibuprofen is well absorbed from the gastrointestinal tract, partially absorbed in the stomach and completely in the small intestine.The time to reach the maximum plasma concentration (Tmax) when taking ibuprofen tablets or ibuprofen suspension for children is from 45 minutes to 1 hour on an empty stomach, and when taken after meals – from 1.5 to 2.5 hours. According to some reports, infants aged 6-18 months have a higher Tmax (3 hours). In human plasma, ibuprofen is more than 90% bound to protein. Although ibuprofen actively binds to albumin, this does not affect drug interactions.
Ibuprofen is extensively metabolized in the liver, rapidly excreted from plasma, and has a relatively short half-life (about 2 hours).The isoenzyme CYP2C9 is involved in the metabolism of the drug. It is excreted by the kidneys and, to a lesser extent, with bile. Urinary excretion of metabolites is usually completed within 24 hours of the last dose. The complete excretion of ibuprofen and its metabolites in the urine is linearly dependent on the dose of the drug.
Antipyretic effect. Ibuprofen has dual anti-inflammatory and antipyretic effects – central and peripheral. The central antipyretic effect of ibuprofen is due to the suppression of the synthesis and release of prostaglandins in the central nervous system.This leads to a normalization of the level of thermoregulation in the hypothalamus, and thus helps to reduce fever.
The peripheral antipyretic effect of ibuprofen is due to inhibition of prostaglandin synthesis in damaged tissues, which reduces the activity of inflammation and the production of endogenous pyrogens, in particular IL-1.
Ibuprofen causes a rapid and effective reduction in high body temperature. The therapeutic effect of the drug begins with a dose of ibuprofen equal to 5 mg / kg.However, the greatest clinical effect is caused by a dose of 7 to 10 mg per 1 kg of body weight; moreover, ibuprofen at a dose of 7–7.5 mg / kg has an antipyretic effect similar to paracetamol at a dose of 10 mg / kg.
The antipyretic effect when taking ibuprofen begins as quickly as when using paracetamol, that is, within 30-40 minutes from the moment of administration. However, in some patients, the body temperature decreases within 15–20 minutes.
Comparison of the effectiveness of paracetamol and ibuprofen showed that both drugs are effective in febrile conditions, but ibuprofen is more potent and long-lasting.
This observation is supported by the results of a large, randomized, double-blind, repeated-dose, parallel-group study in which the effect of ibuprofen at doses of 7 and 10 mg / kg was compared with that of paracetamol at a dose of 10 mg / kg [1]. In patients treated with ibuprofen, mean body temperature was lower than in patients treated with paracetamol.
Ibuprofen was also found to be more effective than paracetamol in reducing very high body temperature (above 39.2 ° C) in children.This action has also been demonstrated in a double-blind study [2]. The effect of single doses of ibuprofen 5 mg / kg and 10 mg / kg, paracetamol 10 mg / kg and placebo was studied. Ibuprofen at a dose of 10 mg / kg was more effective in lowering body temperature than paracetamol at a dose of 10 mg / kg both in the subgroup of children with very high fever and in children of the entire group as a whole.
Thus, ibuprofen in children provides: 90,026
• rapid decrease in high body temperature with fever;
• long-term antipyretic effect, lasting up to 8 hours;
• decrease in body temperature with fever for a longer period of time than when taking a suspension of paracetamol.
This allows us to recommend ibuprofen as the optimal antipyretic drug both for fever of an infectious origin and for stopping post-vaccination reactions.
Pain relieving and anti-inflammatory effects. When choosing NSAIDs, one should also take into account the fact that fever in acute respiratory viral infections, angina, otitis media is quite often accompanied by the development of inflammation and pain of various localization: in the throat, ear, head.
An inflammatory reaction in the upper respiratory tract occurs as a result of viral and bacterial damage to the epithelium of the respiratory tract and the presentation of their antigens by macrophages and other cells of the immune system.In this regard, it is desirable that the antipyretic drug also reduces the inflammatory response and relieves pain.
Ibuprofen relieves pain by inhibiting cyclooxygenase enzymes, which prevents the conversion of arachidonic acid to prostaglandins at the site of inflammation. This reduces the action of prostaglandins on pain receptors, reducing the inflammatory response and resulting tissue damage.
Peripheral action is considered to be the main mechanism by which ibuprofen relieves pain.This drug is especially effective in clinical conditions associated with inflammation, which are accompanied by increased synthesis of prostaglandins. Moreover, it should be borne in mind that paracetamol has no peripheral anti-inflammatory effect.
Given this fact, a number of national pediatric societies recommend the use of ibuprofen as an antipyretic for infections with a pronounced inflammatory component; as well as in cases where the temperature in children is accompanied by painful reactions.
Various studies also show that ibuprofen is an effective treatment for mild to moderate pain in children. In particular, the drug is effective for toothache, acute sore throat with tonsillitis and pharyngitis.
A randomized, double-blind, multicenter study of the efficacy of ibuprofen (10 mg / kg), paracetamol (10 mg / kg), or placebo was performed in children with tonsillitis and pharyngitis [3]. Patients received drugs 3 times a day daily for 7 days along with antibiotics.
After 48 hours of treatment, 80% of children treated with ibuprofen did not complain of any pain. In the group of patients receiving paracetamol, the pain disappeared in 70% of children, and in the placebo group, this figure was 55%. A similar trend was observed in relation to the disappearance of pain when swallowing: 76%, 64% and 43%, respectively.
The efficacy of ibuprofen for reducing ear pain in acute otitis media has been studied in a multicenter, double-blind, controlled trial in children [4].Its results noted that ibuprofen at a dose of 10 mg / kg was effective in reducing pain in otitis media. It was significantly superior in effect to placebo, and there was no significant difference in tolerability between paracetamol and placebo.
Thus, ibuprofen is an effective agent for the short-term treatment of pain syndrome accompanying acute otitis media, tonsillitis and pharyngitis.
Child safety. Short-term treatment with ibuprofen for fever and pain is well tolerated by children.For safety in children, ibuprofen is considered one of the best non-steroidal anti-inflammatory drugs. These are the data of a study that included 84192 children aged 6 months to 12 years [5]. The study evaluated the increased risk of hospitalization in children treated with ibuprofen at a dose of 5 or 10 mg / kg for fever compared with children receiving paracetamol at a dose of 12 mg / kg.
The results indicate that the risk of serious side effects is not higher with ibuprofen than with paracetamol.
Serious gastrointestinal adverse events were very rare. Ibuprofen, compared with paracetamol, did not increase the risk of hospitalization associated with one of 4 serious treatment outcomes, such as gastrointestinal bleeding, renal failure, anaphylaxis, or Reye’s syndrome. There were also no reported drug-related deaths.
Other gastrointestinal adverse events included dyspepsia, abdominal pain, nausea and vomiting.The number of outpatient visits to the doctor about these complaints also did not differ in the comparison groups [5].
A detailed analysis of the remaining adverse events from various organs and systems when using ibuprofen showed the following:
– there were no differences in the frequency of adverse events by age or gender;
– adverse reactions in all cases were insignificant and stopped when treatment was discontinued;
– The risk of visits to outpatient medical institutions for bronchial asthma was significantly lower in the ibuprofen group.Thus, this study demonstrated that ibuprofen is at least as good as paracetamol in terms of safety of use in children with bronchial asthma.
Data on the good tolerability of paracetamol and ibuprofen have been confirmed in other multicenter studies [6-11]. It has been shown that among all analgesics, antipyretics, ibuprofen and paracetamol are the safest drugs. Even with their long-term use, the incidence of adverse events was comparable and amounted to approximately 8-9% for both ibuprofen and paracetamol.
It should be noted that ibuprofen has less toxicity in case of overdose and a high safety threshold compared to paracetamol and acetylsalicylic acid. Unlike paracetamol, ibuprofen does not form toxic metabolites. Ibuprofen has a relatively large therapeutic index, which is about 4 times that of paracetamol.
Symptoms of an ibuprofen overdose may include nausea, vomiting, abdominal pain, headache, hypotension, dizziness, drowsiness, nystagmus, visual impairment, and tinnitus.Metabolic acidosis, renal failure, and loss of consciousness are rare. There is no clear correlation between the doses taken and the clinical effect. Therefore, patients receive symptomatic treatment. Activated charcoal can be used within an hour of taking a high dose or gastric lavage.
Ibuprofen in combination therapy. The combined use of two drugs from the NSAID group is usually not considered rational, since adverse reactions from the gastrointestinal tract are possible.An exception is the combination of paracetamol with other NSAIDs, when the side effects do not increase with the summation of the analgesic effect.
The possibility of combined use of ibuprofen and paracetamol in pediatric practice was evaluated in a randomized study in 146 children aged 6 months to 6 years [12]. To lower the temperature, children were prescribed ibuprofen at a dose of 10 mg / kg, paracetamol at a dose of 15 mg / kg, or both.
The results indicate that in the first 4 hours after taking the drug, the duration of febrile condition decreased by 55 minutes with combination therapy compared with paracetamol.Ibuprofen was comparable to combination therapy for this indicator.
Overall, in 24 hours, the combination of ibuprofen and paracetamol reduced febrile duration by 4.4 hours compared with paracetamol and 2.5 hours compared with ibuprofen. Side effects were not significantly different for all treatment options.
Therefore, it is recommended to start treatment of fever in children with ibuprofen. Moreover, it is possible to add paracetamol to the therapy regimen on the first day of treatment for febrile syndrome.

Literature
1. Sidler J. et al. A double – blind comparison of ibuprofen and paracetamol in juvenile pyrexia. Br. J. Clin. Pract. 1-990; 44 (Suppl. 70): 22-25.
2. Walson P.D. et al. Ibuprofen, acetaminophen, and placebo treatment of febrile children. Clin Pharmacol Ther 1989; 46: 9-17.
3. Bertin L. et al. Randomized, double-blind, multicenter, controlled trial of ibuprofen versus acetaminophen (paracetamol) and placebo for treatment of symptoms of tonsillitis and pharyngitis in children.Journal of Pediatrics 1991; 119 (5): 811-4.
4. Bertin L. et al. A randomized, double-blind, multicenter controlled trial of ibuprofen versus acetaminophen and placebo for symptoms of acute otitis media in children. Fundam Clin Pharmacol 1996; 10: 387-92.
5. Lesko S.M. The safety of acetaminophen and ibuprofen among children less than two years old. Pediatrics 1999; 104 (4) 1-5.
6. Lesko S.M., Louic C., Vezina R., Mitchell A.A. Asthma morbidity after he short-term use of ibuprofen in children.Pediatrics 2002; 109 (2) 1-4.
7. Kauffmann R.E., Sawyer L.A., Scheinbaum M.L. Antipyretic Efficacy of Ibuprofen vs Acetaminophen. AJDC. 1992; 146: 622-625
8. Czaykowski D. et al. Evaluation of the antipyretic efficacy of single dose ibuprofen suspension compared to acetaminophen elixir in febrile children. Pediatric Research, April 1994; Vol. 35, No.4, Part 2, Abstr. 829.
9. Lesko S.M., Mitchell A.A. Renal function after short – term ibuprofen use in infants and children.Pediatrics 1997; 100: 954-7.
10. Autret E. et al. Comparative efficacy and tolerance of ibuprofen syrup and acetaminophen syrup in children with pyrexia associated with infectious diseases and treated with antibiotics. Eur J Clin Pharmacol, 1994; 46: 197-201.
11. Wilson J.T. et al. Single – dose, placebo – controlled comparative study of ibuprofen and acetaminophen antipyresis in children. J Pediatr. 1991; 119: 803-11.
12. Alastair D. Hay et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomized controlled trial.BMJ, 2008; 337; a1302.

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“Knocking down” the child’s body temperature: how to choose the optimal antipyretic agent

It is widely known that in the autumn there is a surge of acute respiratory viral infections (ARVI). The causative agents of ARVI more often cause diseases in preschool children, somewhat less often in schoolchildren, while children are the main spread of infection [1]. Therefore, it is not surprising that the highest risk of transmission of colds is represented by children’s groups.Children actively communicate with each other in schools and kindergartens, exchanging not only information and toys, but also microorganisms. Viruses are transmitted by micro-droplets of saliva, which can spread up to 5 meters when coughing and especially when sneezing! SARS pathogens can also be transmitted by shaking hands and using infected objects. Therefore, if one child is sick, he can easily transmit ARVI to other children and his relatives. Due to the high contagiousness of colds, every second person annually suffers from influenza or ARVI, in contact with the patient [2].Timely ARVI therapy promotes faster recovery and prevents the development of complications. Of course, the treatment of ARVI in children should be not only effective, but also as safe as possible. Young children need special attention.

Fever is the most frequent and one of the most important symptoms of childhood illnesses. Elevated body temperature in a child is the most common reason for visiting a doctor, although often many parents try to lower the temperature on their own using antipyretic drugs [3].Along with antipyretic therapy at elevated body temperature in a child, the measures taken should include:

• semi-bed or bed mode, depending on the level of body temperature and the child’s well-being;
• a gentle diet (feeding based on appetite). It is advisable to limit the consumption of fresh milk because of the possible hypolactasia in case of fever;
• drink plenty of fluids (tea, fruit drink, compote, etc.) to ensure adequate heat transfer due to increased sweating [4].

It is important to understand that an increase in body temperature with ARVI is a physiological protective reaction of the body to the introduction of an infectious agent. The biological significance of fever is to increase the body’s immunological defense, as well as to prevent the multiplication of viruses, cocci and other microorganisms. Therefore, you should not interfere with the child’s body itself to cope with a cold, giving the child antipyretic drugs with a relatively small deviation of body temperature from the norm.It is recommended to use antipyretic drugs when the child’s temperature exceeds 39.0 ° C (measured rectally) or 38.5 ° C (measured “under the arm”). The exceptions are children at risk of developing febrile seizures, with severe diseases of the pulmonary or cardiovascular system, as well as children in the first 2 months of life [3].

During antipyretic therapy, the decrease in body temperature should not be critical, it is not necessary to achieve its normal values, it is enough to lower the temperature by 1–1.5 ° C.This leads to an improvement in the child’s well-being and makes it easier to endure the fever [4].

When choosing an antipyretic drug for a child, along with its effectiveness, the safety profile of the drug is extremely important. WHO recommends 2 drugs – ibuprofen and paracetamol – to control body temperature in children [3].

Ibuprofen has a pronounced antipyretic, analgesic and anti-inflammatory effect. Its efficacy and acceptable safety profile have been proven in international, double-blind, randomized trials.A number of studies have shown that the antipyretic effect of ibuprofen at a dose of 7.5 mg / kg is higher than that of paracetamol at a dose of 10 mg / kg and acetylsalicylic acid at a dose of 10 mg / kg. In addition, ibuprofen does not increase the risk of hospitalizations associated with gastrointestinal bleeding, renal failure, and anaphylaxis compared with paracetamol. Its use is considered relatively safe in comparison with paracetamol in children with bronchial asthma who do not have an indication of acetylsalicylic acid intolerance, since the use of ibuprofen in them does not increase the risk of bronchospasm [5].

Taking into account modern requirements for the efficacy and safety of antipyretics for children, Reckitt Benckiser has developed NUROFEN, NUROFEN FOR CHILDREN and NUROFEN FOR CHILDREN FORTE. Due to the fact that they are presented in three forms of release (oral suspension, suppositories and tablets), parents can choose the most suitable drug depending on the age of the child and even take into account the taste preferences of the baby when choosing the oral form of the drug release:

• NUROFEN FOR CHILDREN, oral suspension with orange or strawberry flavor, 100 mg ibuprofen in 5 ml, will be a good choice for controlling body temperature in babies from 3 months and weighing at least 5 kg and up to 12 years;
• NUROFEN FOR CHILDREN FORTE, oral suspension with orange or strawberry flavor, 200 mg ibuprofen in 5 ml, intended for children aged 6 months and over weighing at least 8 kg and up to 12 years.
• NUROFEN FOR CHILDREN, suppositories, 60 mg ibuprofen in suppositories, are intended for children from 3 months and weighing more than 6 kg to 2 years and are recommended for use when oral administration of drugs is not possible, for example, in case of vomiting in a child;
• NUROFEN 200 mg ibuprofen film-coated tablets are intended for use in adults and children weighing more than 20 kg (approximately 6 years).

One of the important points that should be considered when taking even the safest antipyretic agent is the accuracy of the dosage of the drug.NUROFEN FOR CHILDREN and NUROFEN FOR CHILDREN FORTE in the form of oral suspension contain a convenient dosing device – a syringe-dispenser, which allows you to accurately measure a single dose of the drug for a child. An added bonus is the fact that these drugs have a dosage table both on the secondary packaging (box) and on the bottle itself.

Thus, Reckitt Benckiser took care of the effective and safe control of body temperature in babies, and also took into account important criteria for the convenience of using antipyretic drugs in children – the possibility of accurate dosing and the pleasant taste of drugs in the oral form of release.Therefore, when recommending the optimal antipyretic agent, you should pay attention to NUROFEN FOR CHILDREN and NUROFEN FOR CHILDREN FORTE!

Press service of “Weekly APTEKA”

References

1. Gendon Yu.Z. Etiology of acute respiratory diseases // Vaccination. – 2001. – T. 5. – No. 17. – P. 4–5.

2. Lytkina I. N., Malyshev N. A. Prevention and treatment of influenza and acute respiratory viral infections among epidemiologically significant groups of the population // Attending physician.- 2010. – T. 10. – P. 66–69.

3. Zaitseva OV Some aspects of the effectiveness and safety of therapy for acute respiratory diseases in children // Consilium Medicum (Pediatrics). – 2008. – 2008. – T. 2. – S. 12-18.

4. Timchenko V.N., Pavlova E.B. Modern approaches to the therapy of fever in children with infectious pathology // Pediatric Pharmacology. – 2008. – T. 5. – No. 5.

5. Geppe N.A., Malakhov A.B. Fever in children. The reasons for development and methods of treatment // Child health.- 2009. – T. 200. – No. 1. – P. 16.

Nurofun

Tsikava information for you:

90,000 Paracetamol and ibuprofen: what comes from what?

May 22, 2015

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Photo caption,

Paracetamol has been serving humanity since the 19th century, ibuprofen was synthesized in the middle of the 20th century

Pregnant women should avoid using not only ibuprofen, but also paracetamol. – This conclusion is pushed by the study of Scottish scientists.Long-term use of the latter, they argue, can lead to reproductive disorders in male children.

Scientists from the University of Edinburgh have found that the use of paracetamol by pregnant women for seven days blocks the production of testosterone in the fetus, which can have a detrimental effect on the formation of male reproductive organs.

Until now, it was believed that paracetamol during pregnancy, although undesirable, but can be used for a short time – these are the recommendations of the British National Health Service.

It turns out that both ibuprofen (the most famous drug based on it is “nurofen”) and paracetamol are both quite harmful for women in position.

But what about everyone else? Could the research of Scottish scientists in any way influence our day-to-day choice between these two most popular pain relievers?

We have compiled a small memo where we tried to weigh the pros and cons of using each of the analgesics.

PARACETAMOL

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Caption,

Paracetamol relieves pain and can bring down the temperature

Benefits:

• Most often used to relieve headache, toothache, minor bruises and bruises high temperature.
• The mechanism of action of paracetamol is that it blocks the enzymes released in the body in response to illness and injury, thereby making pain less noticeable to the central nervous system.
• It can be taken by adults and children – with the correct dosage, side effects are minimized.
• An article on AskDrSear.com indicates that the average patient only experiences negative effects when the recommended dose is exceeded eight times.
• Paracetamol can be used in combination with many other cold medicines.

• Unlike ibuprofen, which takes effect half an hour after ingestion, the effect of paracetamol must be waited for about 45-60 minutes.
• The duration of action of the drug is usually limited to four hours, rather than six, as is the case with ibuprofen.
• Paracetamol does not have an anti-inflammatory effect, which makes it less suitable for situations where the cause of pain is inflammatory processes in the body or bodily injury.
• Despite the fact that it is almost safe for the stomach, if the recommended dose is exceeded, it can negatively affect the functioning of the liver.

IBUPROFEN

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Caption,

Like paracetamol, ibuprofen has an analgesic effect, but in addition, it is also an anti-inflammatory agent

Advantages:

pain and inflammation.
• Reduces inflammation at the site of an injury or wound, therefore it is suitable for relieving muscle pain, like any other pain caused by injury, overexertion and tears (micro-tears) of tissues.
• Begins to work faster than paracetamol and lasts longer – up to six hours.

• May have a number of unpleasant side effects such as nausea, vomiting, diarrhea, abdominal pain and digestive upset.
• It is not recommended to use it for a long time for those who have stomach problems: ibuprofen can aggravate peptic ulcer disease and lesions of the gastric mucosa. Taking ibuprofen with or after meals can reduce this risk.
• Internal bleeding is possible – however, these are extremely rare cases.
• May cause poor blood clotting, which is dangerous if the patient has a serious wound or bleeding. Then it is better to use paracetamol to relieve pain.

VERDICT

Photo by EyeWire Inc

Caption,

If the pain is tolerable, British doctors recommend not taking pain relievers

• Both analgesics are effective pain relievers that can also bring down fever.
• Ibuprofen starts to work faster and lasts longer.Plus, it has anti-inflammatory properties.
• Paracetamol has fewer side effects: in particular, it is relatively harmless to the stomach.
• Both drugs can be used simultaneously for a short time. For longer use, a doctor’s consultation is necessary.
• The British National Health Service does not recommend either drug to women during pregnancy. For minor colds and tolerable headaches, it is better not to take medication at all.
• British doctors do not recommend that pregnant women take ibuprofen unless directed by their doctor.
• During pregnancy and lactation, if the patient still needs an analgesic for a short period (to bring down fever or relieve sharp and short-term pain), paracetamol is usually recommended.

Ibuprofen – active substance, effect on the body and composition in

Ibuprofen today is one of the most popular active ingredients in the group of non-steroidal anti-inflammatory drugs (NSAIDs).The indications for its use are extensive: treatment of almost all inflammatory diseases, pain relief, lowering body temperature with fever. In addition, ibuprofen is widely used in the complex therapy of joint diseases.

Ibuprofen for inflammation and pain relief: how it works and how to use it

All processes in our body are regulated by mediators – chemicals involved, among other things, in the transmission of nerve impulses. The sensation of pain is also associated with the release of special pain mediators.Prostaglandins have multiple functions in the body, including regulating pain and inflammation. Prostaglandins are formed from arachidonic acid under the action of an enzyme called cyclooxygenase. Ibuprofen blocks cyclooxygenase, stopping the formation of prostaglandins and, as a result, the development of inflammation.

Once in the body, ibuprofen is absorbed into the blood during the first hour (tmax from 35 to 90 minutes), the maximum concentration in the blood when taking tablets and capsules is achieved in 1-2 hours.There are studies proving that ibuprofen has additional anti-inflammatory properties that act at the level of the cell nucleus. Ibuprofen is available in different dosage forms:

90 095 90 096 Tablets;

Oral medications are usually prescribed in the lowest effective dose in as short a course as possible (7-14 days) to reduce the risk of potential side effects.External agents cause them much less often, since a very small amount of the drug enters the general bloodstream. Ibuprofen is also used in combination with other substances, such as chondroprotectors, to provide additional anti-inflammatory effects.

Because of the possible negative effect on the mucous membrane of the gastrointestinal tract with prolonged courses, ibuprofen is usually prescribed in combination with drugs that protect the gastric mucosa, the so-called proton pump inhibitors.

History of ibuprofen

Of all the anti-inflammatory drugs for ibuprofen, the remarkable thing is that it was discovered as part of the search for a cure for rheumatoid arthritis (joint disease).

In the 1950s, steroids – hormonal drugs – were the only way to relieve symptoms and reduce inflammation. Then the young scientist Stuart Adams was set an ambitious goal – to find a new alternative to steroids that could compete with them in effectiveness, but at the same time had a higher safety profile in terms of side effects.

After ten years of careful research, only a few chemical compounds have been approved for clinical trials by a team led by Stuart Adams. Among them was a substance that we know today as ibuprofen. In 1953, research began on the substance in the UK, and after 16 years it was approved as a prescription drug for reducing pain and inflammation in rheumatoid arthritis. Since the 80s of the last century, ibuprofen has been used to relieve fever and fever, in 1983 it received an over-the-counter status and went into mass sales as an anti-inflammatory, antipyretic and pain reliever drug.

Ibuprofen use for joint pain

Joint pain in most cases is associated with inflammation. The reasons can be different: infectious, immune arthritis or the most common osteoarthritis or osteoarthritis caused by degenerative changes in cartilage and bone tissue. Regardless of the reasons, the mechanism for the development of arthritis is the same: an inflammatory reaction is triggered with the participation of an enzyme – cyclooxygenase. Therefore, ibuprofen, by blocking this enzyme that provokes pain and inflammation, has been shown to be effective in various types of joint diseases.

It is able to reduce pain, swelling, restore range of motion. For the treatment of joint diseases, ibuprofen can be administered orally in the form of tablets or topically in the form of an ointment. In the case of local use, the active substance is applied closer to the focus of inflammation, while in smaller quantities it enters the bloodstream. For joint pain, ibuprofen can also be used in combination with other active ingredients as it further reduces inflammation and pain.

Application features

Use in pregnant women and during lactation

During pregnancy, it is advisable to stop taking medications, since any chemical that enters the mother’s body can affect the fetus.

Application for problems with kidney function

Ibuprofen should not be taken in case of renal failure if creatinine clearance (CC) is less than 30 ml / min. With a CC of 30-60 ml / min, the drug is prescribed with caution, for health reasons. With renal failure, the blood filtration process is disrupted, that is, the drug cannot be fully excreted from the body, its toxicity increases. Any progressive kidney disease is a possible cause of impaired renal function, therefore, in these conditions, NSAIDs are either abandoned altogether or prescribed under constant control of QC.

In case of impaired liver function

The liver metabolizes all substances that enter the body, including drugs. Many of her diseases (cirrhosis, hepatitis) are accompanied by a decrease in organ function. This means that drugs will not be able to undergo adequate “processing” in the liver and will put an additional burden on an already weakened organ. Ibuprofen, unlike some other NSAIDs, does not significantly affect liver function. However, in case of liver pathology in the active stage and with a pronounced decrease in its function, ibuprofen is not prescribed.

90,000 High temperature in a child

Ambulance for children : 8 (812) 327-13-13

Fever is the most common parental concern about the health of children. Often, it is the measurement of body temperature that helps to determine what is happening with the child – he is just in a bad mood or the baby is still ill.

Where, how and how should the temperature be measured?

Body temperature can be measured in various places – in the armpit, in the rectum, in the mouth, in the external auditory canal (by the way, this is not theoretical reasoning – in different countries the temperature is measured differently).In Russia, it is customary to measure the temperature under the armpit – this is exactly what should be done, since each option for measuring temperature has its own normal numbers, and your Russian doctor is used to focusing on the armpit temperature. In turn, being in another country, it makes sense to inform the doctor that the temperature was measured exactly under the arm.
Today, along with the usual mercury thermometers, electronic thermometers are widely used. If you are not a very tidy person, it is better to use just such a thermometer – one broken mercury thermometer will not create problems, but if you are used to hitting them regularly, the level of mercury vapors in your apartment can reach figures that are dangerous to health.Many people complain about the incorrect operation of the electronic thermometer – there are several tricks that will help to cope with this problem. First, having bought an electronic thermometer, you should check it by measuring your temperature with both an electronic and a mercury thermometer – the permissible difference should not exceed 0.2 º. Secondly, especially when measuring the temperature in children, the sound of the buzzer should be ignored and the thermometer should be held for another minute – the result will be more reliable.
A few words about the so-called ear infrared thermometers: one of their undoubted advantages is the speed of measurement – only two seconds.However, at best, you get the temperature of the eardrum – enough to track the temperature dynamics, but it may not satisfy your doctor, because the difference between ear and axillary temperature is not constant and an exact conversion is not possible. In the worst (and very common) case, the ear canal is filled with sulfur – while the numbers on the display of your thermometer will have a very distant relationship to the child’s body temperature. The same can be said for remote infrared forehead thermometers – their accuracy is also far from ideal.
From the “advanced” new products, you can pay attention to the so-called. “Xiaomi smart baby thermometer – a review of this fashionable device can be found here https://news.rambler.ru/other/38877929-obzor-detskogo-termometra-xiaomi-vse-zhivy/
reviews of real users about convenience and accuracy are not bad … It is not difficult to buy this device today, but everything sold is “gray” supplies, since this device does not have mandatory certification in accordance with Russian requirements today.

Thus, the most accurate is the good old mercury thermometer.Everyone knows how to use it, however, I would like to dwell on a few points. First, if the child is sweating, the armpit should be dried first. Secondly, after placing the thermometer, you should make sure that its tip is under the arm, and not sticking out from the outside. Third, keep the thermometer under your arm for at least five minutes. Sometimes these five minutes can be a difficult test for the parent’s psyche – some children absolutely do not like the thermometry procedure. In this case, you can use the old grandmother’s way – put the thermometer not from front to back, but from back to front.At the same time, the child does not see the protruding thermometer and often behaves calmer.
There is a known method for measuring temperature that does not require a thermometer at all – many parents (and especially grandmothers) often claim that they are able to determine the temperature of a child with an accuracy of tenths by touching it with their hand or lips. I strongly advise against using this method – the point is not only that such statements, to put it mildly, are somewhat exaggerated. Unfortunately, this method gives maximum errors precisely when knowing the exact body temperature is especially necessary – with the so-called “pale” fever (we will talk more about this unpleasant condition later).

What temperature should be considered elevated?

Formally, this is considered a temperature above 37º. However, in healthy children of any age, after anxiety, physical exertion or just after eating, the temperature can rise to 37.5 and even up to 38º. Healthy children of the first month of life also do not differ in accuracy in regulating their own temperature, and in premature babies and children with neurological problems, temperature instability can be observed at an older age.In these cases, the temperature measured after an hour is usually normal.
Another condition that can lead to an increase in temperature in a healthy child is teething (or, in other words, dentition). In this condition, the temperature can rise to 38 degrees or more and last for more than a day. However, parents should not decide on their own whether a prolonged increase in temperature is associated with teething. In this case, the child should be shown to the doctor – after all, the child’s teeth are being cut almost continuously from 4 months to 2 years, and, considering any temperature rise as dentition, you can skip the onset of a serious illness, the only symptom of which is visible to you (but not to the doctor) there was a fever.
General overheating of the body can also lead to an increase in temperature, while after a few hours of being in comfortable conditions, the temperature becomes normal and does not rise anymore.
Often the temperature rises after prophylactic vaccinations. Although a moderate rise in temperature after some vaccinations is considered a normal vaccine reaction, in this case it is better to show the child to the doctor.

High fever in a child without symptoms

The body temperature of a sick child is usually elevated. Drawing your attention to this well-known truth, I just want to emphasize that if a fever in a “healthy” child is a reason for serious concern and going to a doctor, then a fever (or, in other words, a fever) in a sick child, examined by a doctor and receiving treatment is a completely normal situation that parents are usually able to cope with on their own (of course, using medical prescriptions). The danger of a high temperature for a child is greatly exaggerated – stories that the heart cannot withstand and many other horror stories are related rather not to medicine, but to folklore.
However, certain medical problems can indeed be associated with high fever. The first (and most frequent) of them is the poor health of a fever child. Indeed, although children usually tolerate fever more easily than adults, prolonged fever can impair a baby’s mood, sleep and appetite. Another problem is a high temperature in children with vomiting or diarrhea: in such children, the main danger is the risk of dehydration, and against the background of a high temperature, fluid loss associated with breathing increases significantly (fluid is spent on humidifying the exhaled air).A third problem (relatively rare) is the problem of febrile seizures (i.e. seizures associated with high fever).

Indeed, some children may develop a convulsive seizure against a background of high temperature. However, this problem is not as terrible as it might seem – firstly, an attack of febrile seizures is always short, goes away on its own and never gives serious complications, and secondly, children over three years of age do not have febrile seizures, and thirdly, if Your child has already been sick with a high fever and without seizures, this problem has nothing to do with him at all.

Is the degree of temperature rise an absolute criterion for the severity of the child’s condition?
Certainly not – the usual uncomplicated ARVI can be accompanied by a temperature above 39º, at the same time, many serious and dangerous diseases can occur with a moderately high or even normal temperature.

How to bring down a high temperature in a child

Do you need to fight the high temperature? If so, how should this be done?
The answer to these questions depends not only on the specific temperature figures, but also on the characteristics of your child, on the nature of the disease that caused the fever and many other factors known only to you and your pediatrician
(the author of this article is unfamiliar with your child).In any case, the appointment of the doctor who examined the child will be much more valuable than any absentee recommendations.
However, you may find yourself in a situation where an emergency doctor’s consultation is not possible. To do this, you do not have to go to a desert island – it is enough to be in a compartment of a long-distance train or in a garden area with a disabled mobile phone. In addition, knowledge of the rational principles of lowering the temperature will help you to correctly assemble your home first-aid kit: medical recommendations, expressed orally or written down on paper, do not have an independent antipyretic effect, and you still need to get to the nearest pharmacy on duty.
In most cases, the temperature below 38º is not dangerous, does not affect the well-being of the child and does not need to be lowered. The desire of parents to achieve a normal temperature in a sick child is completely unjustified – the point is not even that one of the natural factors of the body’s resistance is turned off, just unnecessary use of antipyretic drugs is undesirable, because absolutely safe and harmless drugs do not exist.
Temperatures above 38º should be lowered if the child does not tolerate it well (he often does).The temperature above 39º definitely needs to be reduced, while you still have to use antipyretic drugs, so I will have to tell you more about them.

When you look at the pharmacy shelf with the inscription “antipyretic” you will be surprised by the number of bottles and boxes with different names. In fact, this is an apparent variety – the fact is that the name on the package is a trade name and does not reflect the composition of the drug. So, for example, PANADOL, EFFERALGAN, TAYLENOL, CALPOL, DALERON, PARAMOSHA, CEFEKON D (all these drugs are found in our pharmacies) are ordinary paracetamol.While abroad, you can find the same paracetamol under the names DOLIPRAN, ALVEDON, PARAMOL and others (by the way, you should not expect that the local doctor will explain everything in detail – in many countries this is simply not accepted). Only good eyesight will help you to sort out this confusion – the fact is that on each package there is necessarily an international name of the drug written in small letters: for paracetamol it will be “paracetamol”, “acetomiphen” or “acetominophen”. Today, paracetamol is the most common antipyretic drug for children.
The use of paracetamol in normal doses is harmless for most children, however, if your child suffers from chronic liver disease, has had hepatitis or persistent jaundice of newborns, this drug should not be used without consulting a doctor. Allergic reactions to paracetamol are rare, much more often a child reacts to dyes and taste-improving substances that are part of paracetamol preparations for children. Therefore, if a child develops a rash after taking Panadol, it makes sense to try Efferalgan or Tylenol – perhaps everything will be fine.
NUROFEN FOR CHILDREN is an ibuprofen-based antipyretic drug (look abroad for the word “ibuprofen” on the packaging). In its antipyretic effect, ibuprofen differs little from paracetamol, but it lasts a little longer. This drug in usual doses is of little toxicity and is widely used in modern pediatrics. Unfortunately, ibuprofen preparations are only available for oral administration; rectal suppositories are not produced on its basis. It should only be remembered that ibuprofen is not approved for children weighing less than 5 kg.In addition, ibuprofen preparations should not be used if the child has ever had a decrease in the number of leukocytes in the peripheral blood.
Acetylsalicylic acid (ASPIRIN) is one of the oldest antipyretic drugs. However, today this drug is prohibited for use until the age of 15 – the age-related characteristics of metabolism determine the higher toxicity of this drug specifically for children. The use of aspirin is especially dangerous in children in the first two years of life, as well as those suffering from bronchial asthma or those who are prone to nosebleeds.
ANALGIN (international name – metamizole) is a very effective antipyretic drug. A feature of this drug is the rapid onset of antipyretic effect (especially with intramuscular administration), but the duration of this effect is short. In many countries, this drug is not approved for use – with prolonged and frequent use, analgin can disrupt hematopoiesis, leading to a decrease in the number of leukocytes. In Russia, this drug is used mainly as an emergency aid – leukopenia (a decrease in the number of leukocytes) – a very rare complication and with episodic use of analgin practically does not occur.Conclusions: firstly, analgin can be used in children, but only as an additional antipyretic drug, and secondly, if you intend to use analgin when traveling abroad, you will have to take it with you. An additional argument in favor of the use of analgin can be considered the following consideration: if you cannot reduce the temperature to acceptable levels with the help of paracetamol, you will have to call an emergency aid, whose doctor will certainly help your child – by injecting the same analgin intramuscularly.Of course, analgin should not be used in children with leukopenia of any origin.

How to use antipyretic drugs?

Most of them are available in child-friendly forms – fruit flavored syrups. However, if your child suffers from food allergies, it may be better to separate, crumble and give the child part of the tablet with a little water – this way you avoid the risk of allergic reactions to dyes and flavorings. It should not be forgotten that in addition to the mouth, the child also has other physiological openings suitable for the administration of drugs – I mean the use of rectal suppositories.Most antipyretic drugs are available in various dosages of suppositories. If there are only suppositories with too large a dose of the drug, they are treated in the same way as with tablets – the required part of the suppository (naturally, the front, pointed) is separated with a knife and inserted into the anus, not forgetting to pre-lubricate with baby cream or the anus , or the candle itself. Which is preferable, mouth or butt? There are no fundamental differences in the action of the drug or the rate of absorption, choose what is more convenient for you.

How often can antipyretic drugs be used?

Paracetamol is recommended to be taken no more than four times a day, however, if necessary, the interval between doses can be reduced to four hours. Analgin and ibuprofen (nurofen) should not be taken more than three times a day.
How to calculate the dose of an antipyretic drug? You should not do this yourself, a child’s illness is not the best time for math exercises, you should consult with your doctor in advance.Of course, there is a leaflet with dosage instructions in every box of antipyretic medicine, but these instructions are not specific to your child. By the way, these leaflets often contain an instruction that completely disorients parents: “it is not recommended to take the drug for more than three days” – you can safely ignore this instruction. It is intended for countries where it is not customary to show the child to the doctor in the first days of the disease, and it makes the following sense – if the temperature has not become normal after three days of independent treatment, you should stop the amateur activity and show the baby to the pediatrician.

What if four hours have not passed yet, and the temperature starts to rise again and exceeds 38º?

In this case, rubbing with water at room temperature will help your child. With a large piece of cotton wool soaked in the mixture, you should (like with a brush) moisten the entire skin of the child from the neck to the heels, while it is desirable to cover the perineum, and the axillary and groin areas (the location of large vessels) should be processed several times. After wiping, the child must be left open for 1-2 minutes, after which you can gently get wet.Correct rubdown is quick and effective, but this effect is rather short-lived. It’s not scary, because rubdowns can be carried out as often as you like. But against the background of severe chills, pallor, cold feet (signs of pale fever), you should not wipe yourself off, first you need to transfer the pale fever to pink, about which a little later.

What to do if antipyretic drugs do not work?

The fact is that high temperature (fever) in children can occur in two variants: pink fever and pale fever.With pink fever in a child, the skin looks brighter than in a healthy one, they are hot to the touch, including on the hands and feet, in children older than a year, pink fever is usually accompanied by increased sweating. With pink fever, there is no disturbance in heat transfer, so taking antipyretics is usually effective.
In pale fever, only the head and natural folds are usually hot, and the feet or hands may be especially cold. Pale or marbled skin (i.e.,that is, with an uneven color). Chills and goose bumps are also signs of pale fever. The causes of this condition are a spasm of the skin vessels, the consequences are a violation of heat transfer, the inability to determine the temperature “by touch”, the lack of response to conventional antipyretic drugs and rubdowns.
Pale fever is a very unpleasant condition: vasospasm is not limited to the skin, while blood circulation in tissues is impaired, pathological changes in metabolism increase, and acid-base balance is disturbed.Therefore, the primary task in pale fever is the elimination of vascular spasm, i.e. transfer of pale fever to pink. This can be achieved by using vasodilators – NO-SHPA tablets or PAPAVERIN suppositories (by the way, you will not find NO-SHPU abroad either, take it with you). The disgusting bitter taste of NO-SHPA can be masked by giving it in one spoonful with antipyretic syrup. An additional measure to eliminate vascular spasm is to warm the feet. There is no need to be afraid of this procedure – a heating pad applied to the feet will not lead to an additional increase in temperature, due to the removal of vascular spasm and improvement of heat transfer, the temperature can only decrease.In no case (despite the chills) should the child be wrapped warmly – this will further worsen the heat transfer. In general, the ideal clothing for a feverish child is one’s own skin plus woolen socks.

What to do if you do not know if your child has signs of pale fever?

In this case, follow a very simple rule – it is better to give vasodilators when they are not needed (these drugs are practically harmless in age-related doses) than to skip taking them when they are needed.By the way, a fever above 39º should always be considered pale (without disturbances in heat transfer, the temperature will simply not rise to such figures).
All of the above recommendations can be presented in the form of a short diagram, which is convenient to rewrite and put in a children’s first aid kit.

DIAGRAM OF APPLICATION OF ANTI-REDUCING AND VASCULAR PREPARATIONS AT HIGH TEMPERATURE IN CHILDREN.

1. Temperature below 38º – does not need to be lowered.

2. Temperature 38 – 39º

2.1 PINK FEVER
Signs: pink skin, warm feet, no chills.
Preparations: PARACETAMOL or NUROFEN

2.2 PAIN FEVER
Signs: Pale or marbled skin, cold feet, chills or goose bumps.
Preparations: PARACETAMOL or NUROFEN + NO-SHPA or PAPAVERIN

3. Temperature above 39º
Preparations:
PARACETAMOL or NUROFEN + NO-SHPA or PAPAVERIN + ANALGIN

Note: this scheme cannot be applied if:
1.A child under three months old.
2. The child suffers from a serious chronic illness.
3. The child has had an unusual reaction to one of the recommended drugs in the past.
4. There are contraindications to the use of one of the recommended drugs.
5. The attending physician prescribed a different procedure for the use of drugs.

What to do if, despite following all the recommendations, the thermometer does not drop below 39º or signs of vascular spasm (pale fever) persist?

In this case, you still have to call emergency room .An emergency examination by a doctor in this situation is absolutely necessary – it may be time to change something in the treatment regimen.

In conclusion, I would like to give an approximate list of antipyretic drugs for your home medicine cabinet. A first-aid kit should be completed in advance – children often fall ill at the most inopportune moment, when there is no time and no one to run to the pharmacy.

1. Any syrup with PARACETAMOL or NUROFEN FOR CHILDREN.
2. Suppositories with PARACETAMOL or IBUPROFEN in the dose recommended by the attending physician.
3. Tablets NO-SHPA 40mg.
4. Suppositories PAPAVERIN 20mg.
5. Tablets ANALGIN 500mg.
6. Emergency telephone number.

Kanter M.I.
Pediatrician of the highest category

Choosing the optimal antipyretic agent in pediatric practice | # 08/12

Fever is one of the main reasons for seeking medical care in pediatrics, accounting for up to 30% of all visits to a doctor by children in general and up to 2/3 of visits by children under the age of three [1, 2].

Depending on the etiological factor, it is customary to distinguish two main groups of fever: infectious and non-infectious (with aseptic immune inflammation, tissue damage and dysfunction of the autonomic and central nervous system (CNS)) [3].

In Russia, fever in children is most common in infectious diseases, especially acute respiratory viral infections (ARVI). Most children with ARVI are treated at home, often parents resort to self-medication using OTC analgesics [4].

Meanwhile, moderate fever is an important protective and adaptive reaction of the body, contributing to the death of pathogens of infectious diseases, the production of antibodies, the activation of phagocytosis and immunity. The use of antipyretics is sometimes undesirable due to the fact that they can mask the clinical manifestations of severe infections, delay the establishment of the correct diagnosis, which increases the risk of complications and deaths [5]. In the case when a child is receiving antibiotic therapy, the regular intake of antipyretic drugs can mask the lack of effectiveness of the antibiotic [3].

On the other hand, an increase in body temperature to very high values ​​(> 40 ° C) can contribute to the development of cerebral edema and dysfunction of vital organs [6]. A rise in temperature above 38 ° C is dangerous for children in the first two months of life due to imperfect thermoregulation processes, for children aged 6 months to 3 years who are at risk for the development of febrile seizures, as well as in the presence of severe respiratory and cardiovascular diseases. vascular systems, the course of which may worsen with fever [7].

In children with CNS pathology (perinatal encephalopathy, epilepsy, etc.), seizures may develop against the background of increased body temperature [8]. Febrile seizures are observed in 2–4% of children, more often at the age of 12–18 months [6].

The purpose of prescribing antipyretic drugs for children is not only to prevent the above complications and dehydration, but also to reduce the discomfort associated with fever [9, 10]. Moreover, some experts consider the elimination of discomfort to be the main goal of treating fever in pediatrics [11].

The question of the use of an antipyretic for fever in a child should be decided individually. The risk group for the development of complications in febrile reactions includes children:

• under the age of 2 months with a temperature above 38 ° C;
• with a history of febrile seizures;
• with diseases of the central nervous system;
• with chronic pathology of the circulatory system;
• with hereditary metabolic diseases [12].

Russian pediatricians recommend prescribing antipyretic drugs for children in the first 3 months of life at temperatures> 38 ° C, for children older than 3 months (previously healthy) at temperatures> 39 ° C and / or for muscle aches and headaches [13].

In addition, antipyretics are recommended for all children with a history of febrile seizures at temperatures> 38–38.5 ° C, and those with severe heart and lung disease at temperatures> 38.5 ° C.

Antipyretic therapy should be carried out against the background of the etiological treatment of the underlying disease, and in children with allergic diseases (atopic dermatitis, allergic rhinitis) against the background of the use of antihistamines [4].

When choosing an antipyretic agent, it is always necessary to weigh its benefit / risk ratio for a given pathology, assessed on the basis of the results of adequate randomized controlled trials. It is necessary to give preference to the drugs that are most well studied in pediatrics, of which there are very few today – 75% of drugs on the pharmaceutical market have never been studied in adequate clinical trials in children [14, 15]. An important factor when choosing a drug for children is also the presence of pediatric dosage forms and their organoleptic properties (taste, smell), as well as ease of dosing and use, which makes it possible to increase adherence to pharmacotherapy and prevent medical errors.

Among the drugs with analgesic and antipyretic effects, the best studied in pediatrics are ibuprofen and paracetamol. These drugs are recommended by the World Health Organization, they are the only representatives of their group approved for over-the-counter use for fever and pain in children in most economically developed countries, including the Russian Federation. Paracetamol and ibuprofen can be prescribed to children from the first months of life both in a hospital and at home [3].The use of other non-opioid analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) in pediatrics is limited due to the lack of data on efficacy in this category of patients and due to the risk of serious side effects. Some NSAIDs are approved for prescription only for the treatment of arthritis in children and adolescents.

It should be noted that there are significant differences between paracetamol and ibuprofen, which must be taken into account when choosing antipyretics (table.). Ibuprofen, in contrast to paracetamol, has not only antipyretic and analgesic, but also anti-inflammatory properties, therefore its use is more preferable in children with fever accompanied by inflammatory processes, for example, with angina, otitis media, arthritis, etc. [16].

Evidence for the efficacy of ibuprofen in fever in children

The efficacy and safety of ibuprofen in febrile children has been studied in more than 120 clinical studies, most of which paracetamol was the reference drug [17].

The results of these studies indicate that, both with single use and with repeated doses, ibuprofen is at least as effective as or superior to paracetamol.

For example, in an open-label, randomized, three-parallel-group study of children aged 6-24 months, ibuprofen 7.5 mg / kg was superior to paracetamol and acetylsalicylic acid (both 10 mg / kg) [18 ].

A more pronounced antipyretic effect of ibuprofen at doses of 7.5 and 10 mg / kg compared with paracetamol at a dose of 10 mg / kg has been demonstrated in a number of other clinical studies in children [19–23]. In addition, ibuprofen was shown to reduce high body temperature (> 39.2 ° C) better than paracetamol in a double-blind, placebo-controlled, randomized clinical trial involving 127 children 2–11 years of age [24].

The higher efficacy of ibuprofen as an antipyretic in children at a dose of 5-10 mg / kg compared with paracetamol at doses of 10-12.5 mg / kg was confirmed by the results of a meta-analysis that included 17 blinded randomized clinical trials [17].The superiority of ibuprofen was noted in all the studied time intervals (2, 4 and 6 hours after administration) and was most pronounced between 4 and 6 hours after the start of treatment, when the effect of ibuprofen was more than 30 points higher than the effect of the comparator drug. With exclusion from the analysis of studies in which ibuprofen was used at a dose of 5 mg / kg, its advantage over paracetamol increased even more (the effect was about 2 times stronger than that of paracetamol). The incidence of side effects, including those from the gastrointestinal tract and the kidneys, was the same.

The conclusion on the superiority of ibuprofen over paracetamol in terms of antipyretic and analgesic efficacy in adults and children was also made in the latest published meta-analysis, which included data from 85 comparative clinical studies of these drugs, including 35 studies comparing antipyretic activity [26].

Analysis of published data allows ibuprofen to be recommended as the drug of choice for the treatment of fever in children, since it causes a more pronounced decrease in body temperature than paracetamol without increasing the risk of adverse events [27].

Very interesting data was obtained in the study by Autret-Leca et al. (2007): Although ibuprofen and paracetamol were comparable in efficacy and tolerability, significantly more parents in the ibuprofen group than in the paracetamol group rated the drug their children received as “very effective” both overt and overt. in the blinded phases of the study [28]. The authors believe that such an assessment could be explained by some additional benefit of the drug, which could not be measured in this study, but did reduce parental anxiety about the treatment of their children.

Another study focused on the study of parental satisfaction with the use of their children (n = 490) as antipyretic drugs ibuprofen suppositories at a dose of 5–10 mg / kg / dose [29]. The average assessment of the degree of parental satisfaction on a 5-point scale was 4.5 ± 0.47; 92.2% of parents said they would use this drug in the future.

Comparative studies of ibuprofen with other antipyretics are fewer, since the use of the latter (for example, acetylsalicylic acid and metamizole sodium) in children is limited due to safety concerns.However, the available data suggest that ibuprofen is also superior in efficacy. As mentioned above, ibuprofen at a dose of 7.5 mg / kg was more effective than acetylsalicylic acid at a dose of 10 mg / kg [18].

In a comparative study involving 80 children aged 6 months to 8 years, a single dose of ibuprofen 10 mg / kg had a more pronounced antipyretic effect than a single dose of Dipiron ¹ (metamizole sodium) 15 mg / kg [30]. The benefit of ibuprofen was especially pronounced in children with high (> 39.1 ° C) body temperature.In other comparative clinical studies, ibuprofen was not inferior in efficacy to drugs of metamizole sodium for intramuscular administration, which allowed the authors to recommend giving preference in pediatrics to ibuprofen as a drug for oral administration, the use of which is not associated with pain and other undesirable effects of injections [31, 32].

The advantage of ibuprofen over other antipyretics is the rapid (within 15 minutes) development of the antipyretic effect [32, 33] and its long duration (8 hours) [25].

Ibuprofen has been shown to be an effective agent for the treatment (at a dose of 7.5 mg / kg) and prevention (at a dose of 20 mg / kg / day, divided into 3 doses) of post-vaccination reactions, including fever [34]. The prophylactic effect of the drug in relation to post-vaccination reactions was especially pronounced in children aged 3 months [34].

Despite the fact that the elimination of the discomfort associated with fever is considered as the main goals of prescribing antipyretics, there are practically no targeted studies on this issue.As noted above, one randomized study showed a more favorable effect of ibuprofen on this indicator compared to paracetamol and acetylsalicylic acid [18].

In a small domestic study involving 30 children from 3 months to 2 years old with fever on the background of acute respiratory viral infections, the use of Nurofen suppositories for children (60 mg) led to a faster improvement in well-being, normalization of sleep and appetite than the use of paracetamol suppositories (80 mg) [35 ].

This can be explained both by the wider spectrum of the pharmacological action of ibuprofen, and by its more favorable effect on the temperature curve (rate of onset of the effect, duration of action).It is possible that the reason may be the variable bioavailability of paracetamol in the rectal route of administration [36].

Thus, evidence-based medicine data indicate that ibuprofen has advantages over paracetamol and other antipyretics in terms of effectiveness as an antipyretic agent in children with fever. Many experts believe that ibuprofen should be considered the drug of choice for fever in children and adults [10, 25-28, 37, 38].

The experts’ attitude to combination therapy with ibuprofen and paracetamol is controversial.In a recent double-blind clinical study PITCH comparing the efficacy of a combination of paracetamol (15 mg / kg) and ibuprofen (10 mg / kg) with these drugs alone for fever in children aged 6 months to 6 years with a temperature of 37.8–41, 0 ° C or more, the combination of drugs allowed to normalize body temperature 23 min faster than paracetamol alone, but not faster than ibuprofen [38].

A systematic review that analyzed data from 7 randomized clinical trials failed to show any significant benefits or harms of combination therapy [25].In this regard, the authors of the review consider the use of combination therapy inappropriate. Most other experts also recommend avoiding combination therapy due to safety concerns, including potential drug overdose [10, 11, 38–41]. In the case of combined or alternating use of paracetamol and ibuprofen, it is recommended to record the time of administration of each dose of drugs to prevent overdose [38]. Based on the results obtained, the authors recommended starting treatment of young children with ibuprofen monotherapy as the drug of choice.

Literature

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