Thursday, March 3, 2011

AAP Issues Statement on Treating Fever in Pediatric Patients

From Medscape Medical News

Emma Hitt, PhD

March 3, 2011 — Treatment of febrile children should focus on improving the child's comfort rather than bringing the temperature down to normal levels or preventing the onset of fever, according to a new clinical report issued by the American Academy of Pediatrics (AAP).

Janice E. Sullivan, MD, and Henry C. Farrar, MD, and the AAP's Section on Clinical Pharmacology and Therapeutics, and Committee on Drugs authored the report, published in the March issue of Pediatrics.

"Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a 'normal' temperature," the study authors note. "Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection," they write. "There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications."

According to the study authors, there is "no evidence that reducing fever reduces morbidity or mortality from a febrile illness" or that it decreases the recurrence of febrile seizures.

The article outlines strategies to counsel caregivers about treating febrile illness, stating that acetaminophen and ibuprofen, "when used in appropriate doses, are generally regarded as safe and effective agents in most clinical situations."

The appropriate dosing for acetaminophen is 10 to 15 mg/kg per dose given every 4 to 6 hours orally, which produces an antipyretic effect within 30 to 60 minutes in approximately 80% of children.
The appropriate dosing for ibuprofen is 10 mg/kg per dose.

The study also emphasizes the importance of clear labeling, dosing, and proper storage of medications used to treat fever. It also warns against the use of combination therapy with acetaminophen and ibuprofen because this approach may place infants and children at increased risk for dosing errors and adverse outcomes.

"To promote child safety, pediatricians should advocate for a limited number of formulations of acetaminophen and ibuprofen and for clear labeling of dosing instructions and an included dosing device for antipyretic products," they suggest.

This study was not commercially funded. The study authors have disclosed no relevant financial relationships.

Pediatrics. 2011;127:580-587. Full text

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