Guidelines for the diagnosis and management of acute fever in children
Fever is one of the most common symptoms of pediatric diseases, and is often accompanied by sore throat, headache and other uncomfortable symptoms, and some children may have convulsions. Since children have special physiological characteristics and are in the stage of growth and development, the rational application of drugs is a noteworthy issue for pediatricians. Zhang Bo, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
1 Analysis of several commonly used antipyretic analgesics in pediatrics
The main components of several commonly used antipyretic and analgesic drugs for children in pediatrics are aspirin, acetaminophen and ibuprofen, including single-formula and compound preparations.
1.1 Aspirin is the earliest and most widely used typical drug among antipyretic and analgesic drugs. It has been considered as a good antipyretic and analgesic drug for many years, but with its widespread clinical use, its toxic side effects have become more and more widespread, and the most notable one in recent years is that it can induce Richter’s syndrome (clinically known as acute hepatic fatty encephalopathy syndrome), therefore, some western countries have stipulated that aspirin is prohibited or used with caution.
1.2 Acetaminophen is the most used antipyretic and analgesic drug in the world. It is widely used in pediatrics because of its mild action and low adverse effects. Pediatric preparations containing acetaminophen are widely used clinically, such as Tylenol drops, children’s Benadryl oral solution, etc. In addition to antipyretic effect, Timex Benadryl Drops, (Tylenol) Phenomethamine Oral Solution and Pediatric Aminophenol Flavonamide Granules are also used to relieve other symptoms of pediatric colds, such as pediatric cough and nasal congestion. Dosage】0.25～0.5g per oral dose, 3～4 times a day. 1 day should not exceed 2g, and the course of treatment should not exceed 10 days. Children under 12 years old should take 1.5g per square meter of body surface area per day in divided doses. By age: 2-3 years old, 160mg; 4-5 years old, 240mg; 6-8 years old, 320mg; 9-10 years old, 400mg; 11 years old, 480mg. 1 dose every 4 hours or as necessary. It is not suitable for long-term application. The course of antipyretic treatment usually does not exceed 3 days, and analgesia should not exceed 10 days. Specification】Tablets: 0.16g; 0.3g; 0.5g per tablet. injection: 0.075g; 0.25g. suppository: 0.125g; 0.15g; 0.3g; 0.6g. effervescent punch: 100mg/bag for children, 500mg/bag for adults.
1.3 Ibuprofen is the only non-steroidal anti-inflammatory drug recommended by the FDA for clinical application in the United States, with fast oral absorption, rapid effect and few adverse reactions. The main ingredient of Merlin suspension is ibuprofen. Merlin has been reported to have a longer duration of fever reduction and a stronger antipyretic effect than Bupropion. In addition to the convenience of drug administration, Merlin is more suitable for children because of its good taste and beautiful outer packaging. 【Dosage】Orally: Adults take 200 mg each time, 1 to 3 times daily, up to 800 mg daily; for dysmenorrhea, 200 mg every 8 hours, orally. Take it when you have symptoms, but not normally. Extended release may be 300 mg once or twice daily. Children 1 to 3 times a day, 20-30 mg each time under 1 year old; 60 mg each time from 1 to 3 years old; 100 mg each time from 4 to 6 years old; 150 mg each time from 7 to 9 years old; 180 mg each time from 10 to 12 years old; 200 mg each time from 12 years old and above. Dosage form]] Tablets, extended-release tablets, extended-release capsules, granules, oral solution, suppositories, creams, applications, compounding.
1.4 Nimesulide This product is a non-steroidal anti-inflammatory drug, with anti-inflammatory, analgesic and antipyretic effects. It is absorbed orally and reaches the maximum blood concentration l-2 hours after taking the drug, with a half-life of 3-5 hours, and can continue to work for 6-8 hours. The product is almost completely excreted through urine, even if repeatedly taken, there is no accumulation phenomenon. For children: Only for children over 1 year of age, the dose is 5mg/kg body weight/day, divided into 2 to 3 doses, with the maximum dose not exceeding 100mg, twice a day. For fever reduction, the course of treatment should not exceed 3 days. For rheumatism, the course of treatment should follow medical advice.
1.5 Other ingredients Anacin is an adduct of aminopyrine and sodium nitrite, its antipyretic effect is significant, but the toxic side effects are obvious, mainly in the prolonged application can cause granulocytopenia, and granulocytes are the cells of the body against foreign microbial invasion, they are an important part of human resistance. Therefore, there is not much clinical application of aniracetam tablets, but aniracetam injection is commonly used in pediatrics, mainly for children with high fever. Table 1 Preparations containing aspirin Table 2 Preparations containing acetaminophen Table 3 Preparations containing ibuprofen or other ingredients
2 Rational application of pediatric antipyretic and analgesic drugs
2.1 Selection of medication The selection of appropriate antipyretic and analgesic drugs must be based on the age, condition, side effects and compliance of children: (1) antipyretic drugs with low toxicity and side effects should be selected. acetaminophen is currently recommended by WHO as the preferred antipyretic drug for children over 2 months of age. Tylenol drops are generally recommended for children aged 0 to 3 years. (2) Choose pediatric-specific dosage forms to improve medication adherence. Pediatric Tylonolim drops, Bacitracin oral solution, and Merlin oral solution are administered via the mouth, thus reducing the child’s resistance to intramuscular injection and increasing the child’s cooperation with treatment. Some preparations have a fruit flavor that children like, and the outer packaging is beautiful, with another dropper or measuring cup, easy to take, accurate dose, children are happy to accept, and is also an excellent antipyretic drug necessary for families. It is also reported that the rate of fever reduction of Merlin within 4 h is the same as that of Anacin injection. Oral medication can achieve the speed and effect of injectable medication to reduce fever, so Merlin should become an effective drug to reduce fever, and oral medication is more convenient than injectable medication for home use. (3) Select the medication according to the condition. Pediatric fever is often accompanied by convulsions, and a few children may suffer from brain damage due to prolonged convulsions. In addition to anticonvulsants, strong and rapid antipyretic drugs should be given in a timely manner, such as intramuscular Anacin or Lepidium injection.
2.2 Principles of use Although widely used in clinical practice, antipyretic and analgesic drugs are not safe drugs, especially for pediatric patients, more caution should be exercised: (1) Strictly control the dose, especially injections. Pediatric febrile convulsions are common pediatric emergencies, because the body is sensitive to antipyretic drugs during high fever, so clinical use of Anacin injection to reduce fever in patients with high fever should be careful to control the dose, so as not to cause excessive sweating and cause deficiency. (2) The duration of medication should not be shortened. Read the instructions for use carefully before using the drug. Generally speaking, the antipyretic effect of acetaminophen-containing preparations can last for 4-6 h. If the temperature rises again after cooling, repeated doses may produce superimposed antipyretic effects. (3) Understand the composition of compound preparations to avoid repeated use. As can be seen from Table 2, both Tylenol drops and Phenomethamine oral solution contain acetaminophen, which may increase the incidence of adverse reactions due to overdose if both are administered together.
Pediatric fever is not an independent disease, but is often an important symptom of some infectious diseases, therefore, antipyretic and analgesic drugs are only symptomatic treatment, and the most important thing is to find the cause of fever and treat the cause.
Fever is one of the most common symptoms of pediatric diseases and is often accompanied by sore throat, headache and other uncomfortable symptoms, and some children may have convulsions. Since pediatric patients have special physiological characteristics and are at the stage of growth and development, the rational application of drugs is an issue worthy of attention by pediatricians.
1 Analysis of several commonly used antipyretic analgesics in pediatrics
The main components, efficacy and characteristics of several commonly used antipyretic and analgesic drugs for children are classified in Tables 1~3. From the comparison of the tables, it can be seen that the main components of several commonly used antipyretic and analgesic drugs for children in pediatrics are aspirin, acetaminophen and ibuprofen, including single-formula and compound formulations.
1.1 Aspirin is the earliest and most widely used typical drug among antipyretic and analgesic drugs. For many years, it has been regarded as a good antipyretic and analgesic drug, but with its widespread clinical use, its toxic side effects have become increasingly widespread. In recent years, the most notable is that it can induce Richter’s syndrome (clinically known as acute hepatic fatty encephalopathy syndrome), therefore, some western countries have stipulated that aspirin is prohibited or used with caution. The clinical use of Bamir, APC and Lepirin are all antipyretic drugs in this category. Bamil is an effervescent, water-soluble tablet with fast onset of action, low gastric irritation, sweet and sour taste, and easy to drink. Lepirin is a compound salt of aspirin and lysine, which is used for intramuscular injection. It has a significant antipyretic and analgesic effect, with rapid onset and long-lasting effect.
1.2 Acetaminophen is the most widely used antipyretic and analgesic drug in the world. It is widely used in pediatrics because of its mild action and less adverse effects. Pediatric preparations containing acetaminophen are widely used clinically, such as Tylenol drops, children’s Benadryl oral solution, etc. In addition to antipyretic effect, Timex Benadryl Drops, (Tylenol) Phenomethamine Oral Solution and Pediatric Aminophenol Flavonamide Granules are also used to relieve other symptoms of pediatric colds, such as pediatric cough and nasal congestion. Dosage】0.25～0.5g per oral dose, 3～4 times a day. 1 day should not exceed 2g, and the course of treatment should not exceed 10 days. Children under 12 years old should take 1.5g per square meter of body surface area per day in divided doses. By age: 2-3 years old, 160mg; 4-5 years old, 240mg; 6-8 years old, 320mg; 9-10 years old, 400mg; 11 years old, 480mg. 1 dose every 4 hours or as necessary. It is not suitable for long-term application. The course of antipyretic treatment usually does not exceed 3 days, and analgesia should not exceed 10 days. Specification】Tablets: 0.16g; 0.3g; 0.5g per tablet. injection: 0.075g; 0.25g. suppository: 0.125g; 0.15g; 0.3g; 0.6g. effervescent punch: 100mg/bag for children, 500mg/bag for adults.
1.3 Ibuprofen is the only non-steroidal anti-inflammatory drug recommended by the FDA for clinical application in the United States, with fast oral absorption, rapid effect and few adverse reactions. The main ingredient of Merlin suspension is ibuprofen. Merlin has been reported to have a longer duration of fever reduction and a stronger antipyretic effect than Bupropion. In addition to the convenience of drug administration, Merlin is more suitable for children because of its good taste and beautiful outer packaging. 【Dosage】Orally: Adults take 200 mg each time, 1 to 3 times daily, up to 800 mg daily; for dysmenorrhea, 200 mg every 8 hours, orally. Take it when you have symptoms, but not normally. Extended release may be 300 mg once or twice daily. Children 1 to 3 times a day, 20-30 mg each time under 1 year old; 60 mg each time from 1 to 3 years old; 100 mg each time from 4 to 6 years old; 150 mg each time from 7 to 9 years old; 180 mg each time from 10 to 12 years old; 200 mg each time from 12 years old and above. Dosage form]] Tablets, extended-release tablets, extended-release capsules, granules, oral solution, suppositories, creams, applications, compounding.
1.4 Nimesulide This product is a non-steroidal anti-inflammatory drug, with anti-inflammatory, analgesic and antipyretic effects. It is absorbed orally and reaches the maximum blood concentration l-2 hours after taking the drug, with a half-life of 3-5 hours, and can continue to work for 6-8 hours. The product is almost completely excreted through urine, even if repeatedly taken, there is no accumulation phenomenon. For children: Only for children over 1 year of age, the dose is 5mg/kg body weight/day, divided into 2 to 3 doses, with the maximum dose not exceeding 100mg, twice a day. For fever reduction, the course of treatment should not exceed 3 days. For rheumatism, the course of treatment should follow medical advice.
1.5 Other ingredients Anacin is an adduct of aminopyrine and sodium nitrite, its antipyretic effect is significant, but the toxic side effects are obvious, mainly in the prolonged application can cause granulocytopenia, and granulocytes are the cells of the body against foreign microbial invasion, they are an important part of human resistance. Therefore, there is not much clinical application of aniracetam tablets, but aniracetam injection is commonly used in pediatrics, mainly for children with high fever. Table 1 Preparations containing aspirin Table 2 Preparations containing acetaminophen Table 3 Preparations containing ibuprofen or other ingredients
2 Rational application of pediatric antipyretic and analgesic drugs
2.1 Selection of medication The selection of appropriate antipyretic and analgesic drugs must be based on the age, condition, side effects and compliance of children: (1) antipyretic drugs with low toxicity and side effects should be selected. acetaminophen is currently recommended by WHO as the preferred antipyretic drug for children over 2 months of age. Tylenol drops are generally recommended for children aged 0 to 3 years. (2) Choose pediatric-specific dosage forms to improve medication adherence. Pediatric Tylonolim drops, Bacitracin oral solution, and Merlin oral solution are administered via the mouth, thus reducing the child’s resistance to intramuscular injection and increasing the child’s cooperation with treatment. Some preparations have a fruit flavor that children like, and the outer packaging is beautiful, with another dropper or measuring cup, easy to take, accurate dose, children are happy to accept, and is also an excellent antipyretic drug necessary for families. It is also reported that the rate of fever reduction of Merlin within 4 h is the same as that of Anacin injection. Oral medication can achieve the speed and effect of injectable medication to reduce fever, so Merlin should become an effective drug to reduce fever, and oral medication is more convenient than injectable medication for home use. (3) Select the medication according to the condition. Pediatric fever is often accompanied by convulsions, and a few children may suffer from brain damage due to prolonged convulsions. In addition to anticonvulsants, strong and rapid antipyretic drugs should be given in a timely manner, such as intramuscular Anacin or Lepidium injection.
2.2 Principles of use Although widely used in clinical practice, antipyretic and analgesic drugs are not safe drugs, especially for pediatric patients, more caution should be exercised: (1) Strictly control the dose, especially injections. Pediatric febrile convulsions are common pediatric emergencies, because the body is sensitive to antipyretic drugs during high fever, so clinical use of Anacin injection to reduce fever in patients with high fever should be careful to control the dose, so as not to cause excessive sweating and cause deficiency. (2) The duration of medication should not be shortened. Read the instructions for use carefully before using the drug. Generally speaking, the antipyretic effect of acetaminophen-containing preparations can last for 4-6 h. If the temperature rises again after cooling, repeated doses may produce superimposed antipyretic effects. (3) Understand the composition of compound preparations to avoid repeated use. As can be seen from Table 2, both Tylenol drops and Phenomethamine oral solution contain acetaminophen, which may increase the incidence of adverse reactions due to overdose if both are administered together.
Pediatric fever is not an independent disease, but often an important symptom of certain infectious diseases in clinical practice. Therefore, antipyretic and analgesic drugs are only symptomatic treatment, and the most important thing is to find the cause of fever and treat the cause.