Antipyretic Treatment Research Articles

Feasibility and advantages of normothermia in patients with acute cerebral damage: preliminary results of a prospective randomised study

Even moderate fever soon after head trauma or cerebral ischemia may markedly worsen brain injury. These effects may justify aggressive antipyretic treatment.

Alternating antipyretics: is this an alternative?

To identify current fever management strategies and their basis, and to assess the frequency of alternating acetaminophen and ibuprofen. Practicing pediatricians confront the dilemma of elevated temperature and the anxiety this creates for parents. An informal survey of pediatricians revealed a variety of management strategies, including alternating acetaminophen and ibuprofen. There are no scientific data regarding alternating these 2 products. Design. During professional meetings, pediatricians voluntarily filled out a 15-item questionnaire. One hundred sixty-one completed surveys were reviewed. Respondents were mostly general pediatricians (67.7%), with >/=20 years in practice (55.9%). Most respondents chose a temperature of 101(o)F to start antipyretic treatment (61.9%). A small percentage used discomfort alone as the indication (13%). The antipyretic of choice was temperature-dependent in 50% of respondents; 57% used ibuprofen for temperature >/=102 degrees F. Fifty percent of respondents advised parents to alternate acetaminophen and ibuprofen. The method of alternation varied. The most common answers given for choosing a particular antipyretic regime were recommendations of the American Academy of Pediatrics (29%) and opinions of colleagues and mentors (25%). Physicians with <5 years of practice were significantly more likely to alternate antipyretics (69.7%). Acetaminophen and ibuprofen are commonly being used in an alternating manner for management of fever. There is presently no scientific evidence that this combination is safe or achieves faster antipyresis than either agent alone. There is evidence that the improper use of these agents may cause harm. Despite 29% of participants citing American Academy of Pediatrics recommendations as the basis for fever management, no such policy or recommendations exist. The observation that this practice is more common in younger practitioners may reflect their continued anxiety about fever (fever phobia). Until properly controlled studies have assessed the risk of combining these 2 products, practitioners should proceed with caution.

A study of the efficacy of antipyretic drugs in the prevention of febrile seizure recurrence

ABSTRACT Objective To estimate the potential preventive effect of antipyretic drugs on the recurrence of febrile seizures (FS). Design An experimental and a descriptive patient series, both prospectively followed, were combined in this study. Setting/participants Children who visited the outpatient department of the Sophia Children’s Hospital because of a FS experienced between the age of 10 and 36 months. Intervention A treatment group of 109 children was offered treatment with ibuprofen or acetaminophen syrup during fever, a control group of 103 children was not offered antipyretic treatment. This was not a randomized trial. In an intention‐to‐treat analysis, the risk of any recurrence and the number of recurrences per fever were compared between both groups. In an additional on‐treatment analysis, we compared the number of recurrences per fever between the control group and the children in the treatment group who actually received the study medication during fever. Effect measures were odds ratio (OR) as estimated by the Mantel–Haenszel procedure and hazard ratios (HR) as estimated by Cox regression. Results According to the intention‐to‐treat analysis, the hazard ratio of any recurrence in the treatment group compared with the control group was 1.1 [95% confidence interval (CI), 0.7–1.8]. The recurrence risk per fever was 15% in the treatment group and 12% in the control group (OR, 1.2; 95% CI, 0.7–2.3). In the exploratory on‐treatment analysis, the recurrence risk in the treatment group was estimated 6.9% in the treatment group versus 12% in the control group (OR, 0.5; 95% CI, 0.2–1.3). Conclusions/implications for practice We conclude that antipyretic treatment may have little or no preventive effect on the recurrence of febrile seizures in common practice. Some reduction of the risk of a recurrence may be acquired under optimal circumstances, namely that fever is noticed at once and that antipyretic drugs can be administered on time.

Early vomiting of mefloquine in children with malaria is not modified by the timing of antipyretic treatment

Early vomiting of mefloquine in children with malaria is not modified by the timing of antipyretic treatment

Anti-inflammatory activity of extracts from leaves of Phyllanthus emblica.

Leaves and fruits of Phyllanthus emblica L. have been used for the anti-inflammatory and antipyretic treatment of rural populations in its growing areas in subtropical and tropical parts of China, India, Indonesia, and the Malay Peninsula. In the present study, leaves of Ph. emblica were extracted with ten different solvents (n-hexane, diethyl ether, methanol, tetrahydrofuran, acetic acid, dichloromethane, 1,4-dioxane, toluene, chloroform, and water). The inhibitory activity of the extracts against human polymorphonuclear leukocyte (PMN) and platelet functions was studied. Methanol, tetrahydrofuran, and 1,4-dioxane extracts (50 micrograms/ml) inhibited leukotriene B4-induced migration of human PMNs by 90% and N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP)-induced degranulation by 25-35%. The inhibitory activity on receptor-mediated migration and degranulation of human PMNs was associated with a high proportion of polar compounds in the extracts as assessed by normal phase thin layer chromatography. Diethyl ether extract (50 micrograms/ml) inhibited calcium ionophore A23187-induced leukotriene B4 release from human PMNs by 40%, thromboxane B2 production in platelets during blood clotting by 40% and adrenaline-induced platelet aggregation by 36%. Ellagic acid, gallic acid and rutin, all compounds isolated earlier from Ph. emblica, could not explain these inhibitory activities on PMNs or platelets by Ph. emblica extracts. These results show that the leaves of Ph. emblica have inhibitory activity on PMNs and platelets, which confirm the anti-inflammatory and antipyretic properties of this plant as suggested by its use in traditional medicine. The data suggest that the plant leaves contain as yet unidentified polar compound(s) with potent inhibitory activity on PMNs and chemically different apolar molecule(s) which inhibit both prostanoid and leukotriene synthesis.

The febrile child.

The child with a fever is a common but sometimes difficult problem. The recognition of a serious bacterial infection is usually possible with careful clinical assessment. Occult bacteraemia may be missed and a plan of examination, investigation and management is outlined. The use of antibiotics and antipyretic treatment is discussed.

62 IBUPROFEN AND PARACETAMOL: EFFECTIVE ANTIPYRETICS IN CHILDREN WITH FEBRILE SEIZURES

Introduction The possibility to reduce the risk of febrile seizure (FS) recurrences with antipyretics has gained interest. To compare the antipyretic efficacy of Ibuprofen and Paracetamol in children with FS we performed a randomized, multiple dose, double blind, cross-over clinical trial. Study medication was either Ibuprofen syrup (5mg/kg per dose) or Paracetamol syrup (10mg/kg per dose) at 6 hours intervals during two days. No antibiotics were prescribed.Participants/Measurements 70 patients with a history of FS (mean age 2.1 years) were assigned to treatment at the occurrence of a fever with rectal temperature ≥ 38.5 °C. 22 patients were included during two fevers. Temperature was recorded at 0, 2, 4, 6, 12 and 24 hours after the first dose. Temperature at 4 hours, overall mean temperature and the highest temperature during treament were evaluated. Covariance analysis corrected for base-line temperature, age, weight and clinical fever diagnosis.Main Results Ibuprofen lowered temperature from 39.1 °C base-line to 37.7 °C overall mean, Paracetamol from 39.2 °C to 38.0 °C. Ibuprofen showed 0.50 °C more fever reduction at 4 hours after the initial dose (p=0.04). Also, overall mean temperature was 0.26 °C lower and the highest temperature was 0.30 °C lower during Ibuprofen treatment. In cross-over analysis respective differences were 0.66 °C (p=0.03), 0.40°C and 0.36 °C in favour of Ibuprofen. Two febrile seizures occurred during Ibuprofen treatment and three during Paracetamol treatment.Conclusions Ibuprofen and Paracetamol are effective antipyretics in children with a history of FS. In the studied doses Ibuprofen reduces fever more than Paracetamol. Future clinical trials may determine the value of antipyretic treatment as a prophylaxis of recurrent febrile seizures.

Fever

Body temperature is monitored and regulated by the anterior hypothalamus, which acts as a thermostat by altering the balance of heat production and loss via the sympathetic nervous system. Fever results when the thermoregulatory set point in the hypothalamus is shifted upward. Fever is a part of the acute phase response, a generalized reaction to infection or inflammation initiated by interleukin-1 (IL-1). Prostaglandin E2 is the neural mediator of fever induced by IL-1, so fever can be suppressed by drugs that interfere with prostaglandin synthesis. Fever can be reduced by peripheral cooling, but the preferred method is treatment with antipyretic drugs. Although the host's response to infection is enhanced by small increases in body temperature, antipyretic treatment does not appear to interfere with recovery in humans.

Childhood fever: Correlation of diagnosis with temperature response to acetaminophen: Baker MD, Fosarelli PD, Carpenter RO. Pediatrics. 1987; 80:315–319

Many people believe that temperature response to antipyretics in febrile children varies according to diagnosis. To evaluate the validity of this premise, we prospectively studied the temperature response to acetaminophen of febrile children who came to an urban pediatric emergency and walk-in facility. The study group consisted of 1,559 patients between the ages of 8 weeks and 6 years whose temperatures when seen were greater than 38.4 degrees C and who had not received antipyretic treatment within the previous four hours. Acetaminophen (15 mg/kg) was administered to each child and repeat temperatures were taken one and two hours later. Patient management was unaffected by the study, and physicians were unaware of the repeat temperature measurements. Telephone follow-up was conducted with the parents of each child within five days of the initial visit. Children with cultures positive for bacterial disease or chest x-ray films positive for pneumonia had slightly greater one- and two-hour temperature decreases compared with children with other diagnoses. Although statistically significant, we do not consider these differences in response to be clinically useful. We conclude that fever response to acetaminophen is not a clinically useful indicator by which to differentiate the causes of febrile illnesses in young children.

Childhood Fever: Correlation of Diagnosis With Temperature Response to Acetaminophen

Many people believe that temperature response to antipyretics in febrile children varies according to diagnosis. To evaluate the validity of this premise, we prospectively studied the temperature response to acetaminophen of febrile children who came to an urban pediatric emergency and walk-in facility. The study group consisted of 1,559 patients between the ages of 8 weeks and 6 years whose temperatures when seen were greater than 38.4 degrees C and who had not received antipyretic treatment within the previous four hours. Acetaminophen (15 mg/kg) was administered to each child and repeat temperatures were taken one and two hours later. Patient management was unaffected by the study, and physicians were unaware of the repeat temperature measurements. Telephone follow-up was conducted with the parents of each child within five days of the initial visit. Children with cultures positive for bacterial disease or chest x-ray films positive for pneumonia had slightly greater one- and two-hour temperature decreases compared with children with other diagnoses. Although statistically significant, we do not consider these differences in response to be clinically useful. We conclude that fever response to acetaminophen is not a clinically useful indicator by which to differentiate the causes of febrile illnesses in young children.

Effects of Antipyretics in Rinderpest Virus Infection in Rabbits

Administration of acetylsalicylic acid or mefenamic acid during experimental infection of rabbits with a rabbit-adapted strain of rinderpest virus did not prevent initiation of the febrile response but significantly reduced the duration of fever. Suppression of fever had a markedly deleterious effect on the course of infection, resulting in an increased content of infectious virus in the mesenteric lymph nodes, increased mortality, and retarded recovery in animals that survived the infection. Histological lesions were mainly lymphocytic depletion in lymphoid organs and lymphoid necrosis in both rabbits treated with antipyretics and those left untreated, but damage was more pronounced in the former than in the latter. More viral antigen was detected by immunofluorescence in lymphoid organs of drug-treated rabbits than in those of untreated rabbits. Antipyretic treatment resulted in higher serum interferon levels in the early phase of infection and an increased antibody response in animals that survived the infection.

Antipyretic treatment and typhoid fever: 1860-1900.

Journal Article Antipyretic Treatment and Typhoid Fever: 1860–1900 Get access JAN R. MCTAVISH JAN R. MCTAVISH Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of the History of Medicine and Allied Sciences, Volume 42, Issue 4, October 1987, Pages 486–506, https://doi.org/10.1093/jhmas/42.4.486 Published: 01 October 1987

Antipyretic therapy in ICU patients: evaluation of low dose diclofenac sodium.

The antipyretic effect of diclofenac sodium 0.2 mg/kg i.v. was studied prospectively in 10 ICU patients. Patients with renal failure and hypovolaemia were excluded from the study; mean basal temperature (measured by the pulmonary artery thermistor) was 38.92 degrees C +/- 0.413 SD. In 9 of the 10 patients, the temperature fell by more than 0.5 degrees C within 1 h of administration of the drug. A minimum mean of 37.80 degrees C +/- 0.636 SD was obtained by the hour 3; the temperature then remained lower than basal throughout the entire observation period (6 h). Changes in haemodynamics and oxygen consumption were consistent with the reduction in temperature. Changes in renal function were transient and did not require any therapeutic intervention. We conclude that the proposed dosage (in the selected patient population) constitutes effective antipyretic treatment devoid of major side effects.

Cases Illustrating the Antiseptic and Antipyretic Treatment of Phthisis

Cases Illustrating the Antiseptic and Antipyretic Treatment of Phthisis

Heroic Doses Prompted by Germ Theories.—

During the last twenty-five or thirty years the profession has been strongly influenced by a prevailing therapeutic skepticism. It had become a popular habit to decry active medication in the treatment of almost all forms of disease, and to extol the powers of nature aided by simple hygiene. The reaction from this state of skepticism and expectancy in the treatment of disease, began with the revival of the antipyretic treatment of fevers, and is being pushed on by the rapid development of the doctrines of germ etiology and consequent germicide therapeutics, until even now, it is becoming an important question whether the patients are not in more danger from the large doses of microbe remedies administered in some cases, than from the microbes themselves. Our attention was directed to this subject by two paragraphs in the present number of thisJournal, one under the head of Medical Progress, and the

On the Antipyretic Treatment of Typhoid Fever

On the Antipyretic Treatment of Typhoid Fever

The Antipyretic Treatment in Private Practice

The Antipyretic Treatment in Private Practice

Abstract of Remarks on the Antipyretic Treatment of Typhoid Fever

Abstract of Remarks on the Antipyretic Treatment of Typhoid Fever