Antipyretics in Pediatric Practice
Antipyretics are agents used to reduce fever through action on the hypothalamic heat-regulating center. In pediatric practice, they serve a crucial role in managing febrile conditions and providing symptomatic relief.
Key Points
- Primary goal is to improve comfort, not necessarily normalize temperature
- Most commonly used agents: acetaminophen and ibuprofen
- Temperature >38°C (100.4°F) typically warrants consideration of antipyretic therapy
- Individual response to antipyretics can vary significantly
Clinical Considerations
- Fever is a protective physiological response
- Not all fevers require treatment
- Consider underlying cause when managing fever
- Monitor for signs of serious illness regardless of temperature
Acetaminophen (Paracetamol)
Mechanism of Action
Acts centrally by inhibiting prostaglandin synthesis in the hypothalamus and peripherally blocking pain impulse generation.
Dosing Guidelines
- 10-15 mg/kg/dose every 4-6 hours
- Maximum daily dose: 75 mg/kg/day or 4000 mg/day, whichever is less
- Available forms: oral suspension, tablets, suppositories
Clinical Pearls
- First-line antipyretic in most clinical scenarios
- Better tolerated than NSAIDs
- Can be used in all age groups
- Minimal anti-inflammatory effect
Safety Considerations
- Hepatotoxicity risk with overdose
- Avoid in severe liver disease
- Monitor cumulative daily dose
- Counsel parents on proper dosing
Ibuprofen
Mechanism of Action
Non-selective COX inhibitor with antipyretic, analgesic, and anti-inflammatory properties.
Dosing Guidelines
- 5-10 mg/kg/dose every 6-8 hours
- Maximum daily dose: 40 mg/kg/day or 2400 mg/day
- Age restriction: ≥6 months
Clinical Pearls
- Longer duration of action than acetaminophen
- Superior anti-inflammatory effect
- Particularly effective for inflammatory conditions
- Can be alternated with acetaminophen for refractory fever
Safety Considerations
- GI upset more common than with acetaminophen
- Risk of acute kidney injury in dehydrated patients
- Avoid in children with bleeding disorders
- Use cautiously in asthmatic patients
Clinical Guidelines and Best Practices
Fever Management Strategy
- Initial assessment of fever cause
- Consider age-specific risk factors
- Evaluate need for antipyretic therapy
- Monitor response to treatment
Red Flags
- Fever in infants <3 months
- Temperature >40°C (104°F)
- Signs of serious bacterial infection
- Altered mental status
- Poor response to antipyretics
Parent Education Points
- Proper temperature measurement
- Recognition of concerning symptoms
- Appropriate dosing and timing
- When to seek medical attention
- Importance of maintaining hydration
