Use Of Antipyretics Research Articles

Characterization of postoperative fevers after hemispherotomy.

Patients who have undergone hemispherotomy for intractable epilepsy tend to develop postoperative fevers, which can be severe and/or prolonged, for unclear reasons. The purpose of this paper is to characterize postoperative fever curves after hemispherotomy based on factors including seizure etiology, perioperative blood loss, and the presence or absence of ventricular drainage. We present 72 patients who underwent hemispherotomy at our institution between 1995 and 2013 by four surgeons. Data including daily maximum body temperature, seizure etiology, ventricular drain use, steroid and antipyretic use, and seizure control were gathered retrospectively based on electronic records including operative summaries, nursing notes, discharge summaries, and follow-up clinic notes. Seventy-two patients from 11 weeks to 21 years old (mean 7.4 years old) underwent hemispherotomy between 1995 and 2013. Sixty (83%) had fevers postoperatively, while the remainder were afebrile. Patients without external ventricular drains had higher and more prolonged fevers compared to those with drains (p = 0.003). Patients with Rasmussen's encephalitis tended to have higher postoperative fevers than patients with other seizure etiologies (p = 0.005), while patients with cortical dysplasia and polymicrogyria tended to have less severe fevers (p = 0.027 and 0.017, respectively). Fifty-five patients (76%) had freedom from disabling seizures (Engel class I), and 96% showed worthwhile improvement or better (Engel classes I-III). Postoperative fever can be anticipated in hemispherotomy patients, may vary based on certain seizure etiologies, and may be mitigated by routinely utilizing external ventricular drainage. Hemispherotomy is an effective surgical procedure for intractable epilepsy in selected patients.

The Validity and Reliability of the Parent Fever Management Scale: A Study from Palestine

Parental concern about childhood fever and consequent use of antipyretics is increasing. Little is known about childhood fever management among Arab parents. No scales to measure parents' fever management practices in Palestine are available. The aim of this study was to validate the Arabic version of the Parent Fever Management Scale (PFMS) using a sample of parents in Palestine. A standard "forward-backward" procedure was used to translate PFMS into Arabic language. It was then validated on a convenience sample of 402 parents between July and October 2012. Descriptive statistics were used, and instrument reliability was assessed for internal consistency using Cronbach's alpha coefficient. Validity was confirmed using convergent and known group validation. Applying the recommended scoring method, the median (interquartile range) score of the PFMS was 26 (23-30). Acceptable internal consistency was found (Cronbach's alpha = 0.733) and the test-retest reliability value was 0.92 (P < 0.001). The Chi squared (χ (2)) test showed a significant relationship between PFMS groups and frequent daily administration of antipyretic groups (χ (2) = 52.86; P < 0.001). The PFMS sensitivity and specificity were 77.67 and 57.75 %, respectively. The positive and negative predictive values were 67.89 and 32.11 %, respectively. The Arabic version of the PFMS is a reliable and valid measure and can be used as a useful tool for health professionals to identify parents' fever management practices. The Arabic version of the PFMS can be used to reduce unnecessary parental practices in fever management for a febrile child.

Supplementation of infant formula with milk fat globule membranes improves cognitive performance and reduces infections in formula‐fed infants (38.2)

Unidentified breast milk factors may explain some of the observed differences in neurodevelopment and infectious diseases between formula‐fed and breast‐fed infants. Breast milk contains MFGM, a source of several bioactive components, whilst infant formula (IF) does not. A double‐blind RCT was performed to elucidate whether supplementation of formula with bovine MFGM would improve neurodevelopment and reduce morbidity in infectious diseases. Stratified for sex, 160 healthy term infants &lt;2 mo were randomized to standard formula (SF) or experimental formula (EF) supplemented with a bovine MFGM‐enriched fraction until 6 mo of age. Breast‐fed infants (n=80) served as a reference group (BFR). Cognitive, motor and verbal function was assessed using Bayley III at 12 mo of age. Disease symptoms were recorded prospectively by parents. The cognitive score (mean ±SD) was higher in the EF group (105.8 ± 9.2) than in the SF group (101.8 ± 8.0), p=0.008, and there was no difference in cognitive score between the EF group and the BFR group (106.4 ± 9.5), p=0.73. There were no differences in motor or verbal scores between the EF and SF groups. The EF group had significantly lower incidence of acute otitis media (p = 0.034) and use of antipyretics (p= 0.021) during the first 6 mo compared to the SF group. In conclusion, bovine MFGM includes factors essential for optimal development of both cognitive and immune function and can be supplemented to IF.

¿Se ha modificado el uso de antitérmicos tras la introducción de ibuprofeno a diferentes concentraciones?

IntroductionDue to the emergence of new pharmaceutical presentations of ibuprofen (40mg/ml), an analysis was made on the use of antipyretics in pediatric outpatient in Spain. Patients and methodsA cross-sectional, observational, descriptive study was carried out on a sample of children under 14 years old with treated febrile syndrome, seen in the Emergency Room of the Hospital General Universitario de Valencia from November 2012 to January 2013. ResultsOf the 217 children included, 144 were treated with paracetamol or ibuprofen, 69 received both drugs, and one received paracetamol and metamizol. There were 58.7% of exposures to paracetamol and 40.9% to ibuprofen. The parents decided the use of antipyretics in 63.2% of cases. In 98 exposures the dose was different from that authorized in the labeling of the drug (off-label use). Ibuprofen was used off-label in 40.2% of cases, mostly by underdosing (35.9%). Paracetamol was used off-label in 29.8% of cases, predominantly overdose (26.8%), with the difference being statistically significant. No significant differences were observed in the off-label use in either monotherapy or combined use. There were also no differences when antipyretics prescribed by doctors or given directly by parents were evaluated separately. ConclusionsThe majority of children with treated febrile syndrome seen in the Emergency Room were receiving antipyretic drugs after a parental decision. Paracetamol is the most commonly used drug and one in three children received it simultaneously with ibuprofen. The antipyretics were used off label in one-third of the cases. Off label use of ibuprofen is increasing, and is probably due to the existence of different pharmaceutical presentations.

Population-level effects of suppressing fever.

Fever is commonly attenuated with antipyretic medication as a means to treat unpleasant symptoms of infectious diseases. We highlight a potentially important negative effect of fever suppression that becomes evident at the population level: reducing fever may increase transmission of associated infections. A higher transmission rate implies that a larger proportion of the population will be infected, so widespread antipyretic drug use is likely to lead to more illness and death than would be expected in a population that was not exposed to antipyretic pharmacotherapies. We assembled the published data available for estimating the magnitudes of these individual effects for seasonal influenza. While the data are incomplete and heterogeneous, they suggest that, overall, fever suppression increases the expected number of influenza cases and deaths in the US: for pandemic influenza with reproduction number , the estimated increase is 1% (95% CI: 0.0-2.7%), whereas for seasonal influenza with , the estimated increase is 5% (95% CI: 0.2-12.1%).

Adherence among Italian paediatricians to the Italian guidelines for the management of fever in children: a cross sectional survey

BackgroundItalian guidelines for the management of fever in children (IFG) have been published in 2009 and thereafter disseminated in all country. A survey was conducted before their publication and three years later to investigate their impact on knowledge and behaviors of paediatricians.MethodsA questionnaire was administered to convenient samples of paediatricians in 2009 and in 2012, eliciting information about fever definition, methods of temperature measurement, and antipyretic use. Differences in responses between 2009 and 2012 and between paediatricians who were or were not aware of the IFG were evaluated.ResultsThe responses rates were 74% (480/648) in 2009 and 69% (300/434) in 2012. In 2012 168/300 (56%) of participants were aware of the IFG. The proportion of paediatricians who correctly would never suggest the use of physical methods increased from 18.7% to 36.4% (P < 0.001). In 2009 11% of paediatricians declared that the use of antipyretic drugs depends on patient discomfort and did not use a temperature cut off. In 2012 this percentage reached 45.3% (P < 0.001). Alternate use of antipyretics decreased from 27.0% to 11.3% (P < 0.001). Use of rectal administration of antipyretics in absence of vomiting decreased from 43.8% in 2009 to 25.3% in 2012 (P < 0.001). In general, improvements were more striking in paediatricians who were aware of the IFG than in those who were not aware of them.ConclusionsBehaviours of Italian paediatricians improved over time. However, some wrong attitudes need to be further discouraged, including use of physical methods and misuse of rectal administration. Further strategy to disseminate the IFG could be needed.

Assessment of Nurses' Knowledge and Attitudes toward Fever Management for Children at Assiut Children University Hospital

Fever is one of the most common presenting signs of illness in office based primary care pediatric practice, accounting for 19% to 30% of visits. Fever is also the second most common reason for hospital admission of children. The aim of this study: is to assess nurses' knowledge and attitude toward fever management. Descriptive research design was utilized to meet the aim of this study. Subjects and method: This study was conducted in eerttunits (Gastroenterology Unit, Intermediate and Intensive Care Units ) at Assuit Children University Hospital. The subjects of this study consisted of 73 nurses who were working in the previous units. Two tools were used to collect the required data for this study, tool one: Structured questionnaire sheet for assessment of nurses' knowledge regarding fever and fever management, tool two: Fever management attitude scale (FMA) for assessment of nurses' attitude related to fever and fever management (Walsh et al., 2005). Results: The main results of study demonstrated that 78.1% of studied nurses had unsatisfactory knowledge about fever and fever management. Statistically significant difference was illustrated between nurses place of work and their total percent score of knowledge (p-value =0.021). It was shown that nurses who worked at intensive care unit have satisfactory score of knowledge compared with the nurses who worked at intermediate care unit (34.5% and 23.1% respectively). It was noticed that antipyretic use without doctor order was reported by 43.8% of nurses. Forty six and half percent of nurses (46.5%) had negative attitude toward antipyretics were minimally effective in preventing recurrences. Most nurses (83.6%) disagreed that febrile convulsions do not cause neurological damage. Conclusion: More than three quarters of nurses included in this study had unsatisfactory knowledge about fever and fever management. All nurses have positive attitude toward fever and its management. Recommendations: Carrying out health education programs for all nurses to improve a general knowledge and attitude toward fever and its management.

Maternal flu or fever, medications use in the first trimester and the risk for neural tube defects: a hospital-based case–control study in China

This study aims to evaluate the effects of maternal flu or fever, and medications (antibiotics and antipyretics) use in the first trimester on neural tube defects (NTDs) risk in offspring. Data came from a hospital-based case-control study conducted between 2006 and 2008 in Shandong/Shanxi provinces including 459 mothers with NTD-affected births and 459 mothers without NTD-affected births. Logistic regression models were used to evaluate the effects of maternal flu, fever, and medications use on NTD risk. The effects were evaluated by adjusted odds ratio (OR) and 95 % confidence intervals (CIs) with SAS9.1.3.software. NTDs risks were significantly associated with maternal flu or fever (OR = 2.63, 95 % CI = 1.64-4.23) and antipyretics use (OR = 3.38, 95 % CI = 1.68-6.79), but not with antibiotics use (OR = 1.82, 95 % CI = 0.85-3.93). The risk effect of antipyretics use on anencephaly (OR = 7.81, 95 % CI = 1.96-31.13) was markedly higher than on spina bifida (OR = 3.02, 95 % CI = 1.08-8.42). Maternal flu or fever together with antipyretics use showed a higher OR for total NTDs (3.27 vs.1.87), anencephaly (7.38 vs.2.08), and spina bifida (2.97 vs.2.07) than maternal flu or fever with no antipyretics use. Maternal flu or fever and antipyretics use in the first trimester were risk for NTDs. Maternal flu or fever together with antipyretics use increased NTD risk than only maternal flu or fever.

Does the Use of Antipyretics in Children Who Have Acute Infections Prolong Febrile Illness? A Systematic Review and Meta-Analysis

To review the literature and test the hypothesis that the use of antipyretic drugs in children with acute infections slows recovery. A systematic review and meta-analysis of the literature was undertaken to investigate the effect of antipyretic drugs upon recovery from infectious diseases in children. A search of Medline (1946 until November 2012) and EMBASE (1980 until November 1, 2012) was undertaken to identify studies in which the authors compared the use of antipyretic medications with nonpharmacologic treatments for fever. Six papers were identified, 5 of which were included in the meta-analysis. Three studies focused on children with malaria and the other 3 considered general viral and respiratory infections and varicella. The pooled mean difference in time to fever clearance was 4.16 hours and was faster in those receiving antipyretics compared with those not (95% CI -6.35 to -1.96 hours; P = .0002). There was little evidence of statistical heterogeneity (χ(2) 4.84; 4 df; P = .3; I(2) 17%). There is no evidence from these studies that the use of antipyretics slows the resolution of fever in children.

Consider the risks and benefits of treatment when using over-the-counter pain medications in children

Paracetamol and ibuprofen are effective over-the-counter analgesics for use in children. Each of these agents is generally well tolerated, although paracetamol has a more favourable safety profile, making it the first-line analgesic for mild pain and young children, while ibuprofen is the first choice for significant musculoskeletal pain. Dipyrone, salicylates, and the routine use of antipyretics for fever, should be avoided.

Fever Literacy and Fever Phobia

To identify the percentage of parents who define the threshold for fever between 38.0°C and 38.3°C, which has not been reported previously, and to describe parental attitudes toward fever and antipyretic use. Thirteen-question survey study of caregivers. Overall, 81% of participants defined the threshold for fever as <38.0°C, 0% correctly defined fever between 38.0°C and 38.3°C, and 19% defined fever as >38.3°C. Twenty percent of children brought to clinic for a chief complaint of fever were never truly febrile. Ninety-three percent of participants believed that high fever can cause brain damage. For a comfortable-appearing child with fever, 89% of caregivers reported that they would give antipyretics and 86% would schedule a clinic visit. Our finding that 0% of parents correctly defined fever is both surprising and unsettling, and it should inform future discussions of fever between parents and clinicians.

Comparison of cold water sponging and acetaminophen in control of fever among children attending a tertiary hospital in South Nigeria

Background:A wide range of childhood illnesses are accompanied by fever, leading to varied attempts at treatment by caregivers at home before coming to a hospital. Common modalities of treatment include use of antipyretics and physical methods such as cold water sponging, fanning and removal of clothing. These treatment modalities have been received with varied attitudes among physicians and the scientific community. This study was to assess the efficacy of both modalities in first-line management of fever in our area.Objectives:The main aim of the study is to compare the effectiveness of cold water sponging with that of oral paracetamol in the treatment of fever in children attending the University of Calabar Teaching Hospital, Calabar.Subjects and Methods:This is a randomized clinical trial. Eighty-eight children aged 12-120 months who presented to the Children Outpatient Clinic (CHOP) and the Children Emergency Room (CHER) of University of Calabar Teaching Hospital, Calabar, with acute febrile illness and axillary temperatures spanning ≥ 38.0-40.0°C. All children within the age limit whose caregivers gave consent were recruited into the study and were randomized to receive either cold water sponging or oral paracetamol. Axillary temperature, pulse rate, respiratory rate and assessment of discomforts (crying, shivering, goose pimples and convulsions) were recorded every 30 min for 2 h. The results were analyzed using the SPSS statistical software and have been presented in the tables.Results:Cold water sponging was very effective in temperature reduction within the first 30 min, with 29 (70.73%) having their temperature reduced to within normal limits. This declined to 12 (29.26%) at 60 min and 4 (10.53%) at 120 min, with the mean temperature differences from the baseline value following the same trends (1.63°C by 30 min, 0.91°C by 60 min and 0.39°C by 120 min). When compared with paracetamol, cold water sponging was more effective in temperature reduction within the first 30 min (P = 0.000), with the difference in effect at 60 min less significant between these two groups (P = 0.229). Paracetamol demonstrated a gradual and sustained reduction in temperature with the proportions of afebrile children in this group increasing from 7 (16.27%) at 30 min to 33 (78.57%) at 120 min. The mean temperature differences from the baseline value also showed the same trend. Children who received cold water sponging had more discomforts compared with those who received only oral paracetamol.Conclusions:It is concluded that cold water sponging, although producing rapid reduction in temperature compared with paracetamol, has effects that last only for a short time. Paracetamol on the other hand produces a gradual but sustained effect. The discomforts experienced should not be a limiting factor to the use of cold water sponging in reducing the body temperature of febrile children. Cold water sponging is safe and its use by mothers and primary caregivers should be encouraged while preparing to take the child to the nearest health facility for definitive treatment of the underlying cause of the fever.

Antipyretic use in children: more than just temperature

Antipyretic use in children: more than just temperature

Antipyretic use in Children: More than Just Temperature

the cyclooxygenase enzymes COX-1 and COX-2. The former, which is constitutively expressed, is thought to be primarily responsible for maintaining homeostasis. The latter, which is induced by a range of cytokines including IL-1 and TNF-a, 3 is mainly responsible for fever and inflammation, a syndrome sometimes referred to as phase It is possible to construct both evolutionary and immunological arguments for the benefit of fever, based on its ubiquity throughout the animal kingdom and the important role of cytokines in the immune response. However, clinical studies have proved to be more difficult to conduct; even when performed, the results were not conclusive, and it is impossible to separate the possible beneficial effect of fever from the other parts of the acute phase response. 4,5

Therapeutic conducts and alternating antipyretics in the management of fever in children.

OBJECTIVES: To describe therapeutic conducts and the alternate use of antipyretics in children, and to evaluate factors associated with this use. METHODS: Cross-sectional study with 692 children from 0 to 6 years, living in southern Brazil. Through cluster sampling, we carried out household interviews with caregivers, using a structured questionnaire. A descriptive analysis was performed and the association between sociodemographic factors and the alternate use of antipyretics was evaluated. We analyzed 630 cases (91.0%), corresponding to children with history of fever. RESULTS: Around 73% of the caregivers answered that their first action with respect to a rising temperature was to medicate the child. The mean temperature considered fever by the caregivers was 37.4 °C and high fever, 38.7 °C. The use of alternate antipyretics was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical advice, in most cases. The most widely used drugs were dipyrone and paracetamol. Children whose main caregiver was a parent, with better economic conditions and higher educational level were more likely to use alternating therapy. Around 70% of the doses used were below the minimum recommended. CONCLUSIONS: The administration of medication to control fever is a common practice, including alternating antipyretics. Most caregivers consider fever some temperatures below those recommended, and pointed out non-response and medical advice as the main reasons for alternating antipyretics.

Some economic and socio-cultural factors associated with cerebral malaria among under-fives in Benin City, Nigeria.

Introduction: Risk factors associated with the occurrence of cerebral malaria in under fives are well documented. Outside these acknowledged factors of age, location, and nutrition, other socioeconomic/cultural factors could contribute to the maze of factors determining the occurrence of the morbidity. Methods: To unravel such factors a key informant interview was conducted among resident doctors in paediatrics at the University of Benin Teaching Hospital. Factors identified formed the basis of this cross-sectional, case control study involving 64 cases each of subjects and controls with uncomplicated malaria carried out at the Hospital. Such factors as delay in accessing competent intervention, prolonged use of anti-pyretics, material educational status, use of substandard medication and abdominal scarification as identified were evaluated in the two sets of patients. Others evaluated included mothers&#8217; occupation and health seeking behaviours. Results: Factors found to be significantly associated with occurrence of cerebral malaria were initial treatment in clinics (X2 = 6.43, p = 0.011) presence of fresh abdominal scarification (X2 = 4.30, p=0.038) late presentation (X2 = 32.64; p=0.000) and non- use of mosquito nets (X2 = 9.14; p=0.002). Conclusion/Recommendations: Initial treatment either in clinics or non orthodox facilities contributed significantly to the occurrence of cerebral malaria. The implication of these is that pre- teaching hospital treatments were inadequate in managing the child meant to develop cerebral malaria. Attention should therefore be directed at these areas alongside use of mosquito nets if the objective is to minimise the occurrence of cerebral malaria.Key words: Cerebral malaria, Risk factors, Under fives, Economic factors &amp; Socio-cultural factors.

Immunogenicity and Safety of Two Tetravalent (Measles, Mumps, Rubella, Varicella) Vaccines Coadministered With Hepatitis A and Pneumococcal Conjugate Vaccines to Children Twelve to Fourteen Months of Age

This study compared single-dose tetravalent measles, mumps, rubella, varicella vaccine, Priorix-Tetra, stored refrigerated (GSK+4C) or frozen (GSK-20C), with ProQuad (Merck-20C), when coadministered with hepatitis A vaccine (HAV) and 7-valent pneumococcal conjugate vaccine (PCV7). Multicenter, observer-blind phase 2 study in 1783 healthy 12-14 month olds randomized to: GSK+4C (n = 705), GSK-20C (n = 689) or Merck-20C (n = 389), administered concomitantly with HAV (Havrix) and PCV7 (Prevnar). Seroresponse rates and antibody geometric mean concentrations/titers were determined from enzyme-linked immunosorbent assay and neutralization assays. Reactogenicity and safety were assessed. Seroresponse rates (day 42) were >97% for measles and rubella viruses and >92% for mumps virus, in all groups. Noninferiority of both GSK+4C and GSK-20C vaccines versus Merck-20C was demonstrated for seroresponse rates to measles, mumps and rubella viruses (lower 97.5% confidence interval above -5%, -10% and -5%, respectively). For varicella-zoster virus, seroresponse rates were 57.1%, 69.8% and 86.7% in the GSK+4C, GSK-20C and Merck-20C groups, respectively. Noninferiority was not shown for either GSK vaccine (lower 97.5% confidence intervals <-15%). Geometric mean concentration ratios for anti-varicella-zoster virus demonstrated noninferiority (lower 97.5% confidence interval ≥ 0.5) versus Merck-20C for GSK-20C only. Geometric mean concentration ratios for antibodies to HAV and to PCV7 pneumococcal serotypes also met criteria for noninferiority for both GSK groups compared with Merck-20C. GSK vaccine safety was observed comparable to Merck-20C. Localized but not generalized measles/rubella-like rash and grade 3 fever was reported slightly more frequently with GSK vaccines, but antipyretic use was similar. The incidence of subjects experiencing at least 1 serious adverse event was 2.0%, 2.9% and 1.8% in the GSK+4C, GSK-20C and Merck-20C groups, respectively. Noninferiority of both GSK measles, mumps, rubella, varicella vaccines versus Merck-20C was demonstrated for responses to measles, mumps and rubella viruses but was not fully demonstrated for varicella-zoster virus. The vaccines showed acceptable reactogenicity/safety when coadministered with HAV and PCV7.

The Croatian Society of pediatric neurology guidelines for the diagnosis and therapy of febrile seizures

Febrile seizures are occasional cerebral seizures that occur in 2%-5% of children aged 6-60 months. Despite progress in the understanding of febrile seizures pathophysiology and the development of its guidelines, there are still many variations in the interpretation of these guidelines and in the evaluation and treatment of children with febrile seizures in the Republic of Croatia. Therefore, the Croatian Society of Pediatric Neurology developed the guidelines for the rational diagnosis and therapy of febrile convulsions, which should be feasible in all hospitals in the Republic of Croatia. The purpose of these guidelines is to assist in making rational decisions for diagnosis and treatment and they do not represent the only possible protocol for all patients with this disorder. An additional specific objective is to emphasize the medical evidence based approach to the risk and benefit of continuous and intermittent prophylactic antiepileptic therapy, as well as to the use of antipyretics in children with febrile seizures. Despite the high prevalence and percentage of relapses of febrile seizures, long lasting effects are not known nor scientifically proven in the literature. The risk of developing epilepsy in these patients is low, although slightly higher than in the general population. There is no evidence that the prophylactic use of antiepileptic drugs in children with simple febrile seizures can reduce the incidence of epilepsy. There is no evidence that the use of intermittent diazepam prophylaxis of simple febrile seizures is rational and reasonable. Continuous prophylaxis with antiepileptic drugs or intermittent diazepam therapy may reduce the incidence of recurrent febrile seizures. However, the risk of side effects and potential toxicity of antiepileptic drugs beyond the already low risk of complications in children with simple febrile seizures does not recommend continuous or intermittent therapy with antiepileptic drugs in children with simple febrile seizures. Antipyretics have not been shown to be effective in preventing recurrence of febrile seizures.

Current challenges in the diagnosis and management of fever

We review recommendations from recent publications on the management of fever with antipyretics, the classification and diagnosis of fevers of unknown origin (FUO), and the evaluation of fever in infants under 90 days of age. Anxiety about fever persists in the population, while the toxicity of antipyretics is an increasing concern. The numerous opportunities for overdosing with antipyretics have been emphasized by the American Academy of Pediatrics (AAP). The practice of alternating acetaminophen and ibuprofen has limited value. Nonclassic FUO and pseudo-FUO are as important to consider as true FUO, and clinicians should become familiar with the variety of periodic fever syndromes. The clinical utility of low-risk criteria to identify febrile infants at low risk for serious bacterial infection (SBI) was demonstrated in a systematic review of studies. Pediatricians should spend more time educating parents about fever and antipyretic use. Not all persistent fever is FUO, and testing should be targeted to the child's clinical condition. Existing low-risk criteria should be used to identify febrile infants who can be managed without extensive work-up and antibiotics. Adherence to evidence-based recommendations will lessen the morbidity and mortality associated with febrile illnesses in children.

Antipyretic use after infant immunization

Sharon Westcar, Karen Ford, Sarah Kelly and Matthew Snape compare the effectiveness of ibuprofen and paracetamol on treating adverse reactions after immunization