Unlike adults, children’s organ functions are not fully developed and their liver detoxification and kidney excretion functions are weak, so they are less tolerant to drugs. Children’s respiratory diseases rank first in children’s diseases, and the demand for respiratory medication is high, so improper prescription by clinicians is easy to prevail. In order to avoid the harm caused by improper medication for treating children’s respiratory diseases and to improve the medical staff’s knowledge about the safety of children’s respiratory medication, some domestic pediatric respiratory experts have jointly developed the “Expert Consensus on the Safe Use of Children’s Respiratory Medication: Cold and Fever Medication” for pediatricians’ reference by referring to relevant domestic and foreign research data and medication norms.
1.Expectorants: mainly by diluting phlegm or liquefying mucus phlegm to make it easy to cough up, the commonly used expectorants are divided into 3 categories according to their mode of action.
(1) Nausea expectorants or stimulating expectorants: the former, such as guaiacol glycerol ether, ammonium chloride, potassium iodide, Yuanzhi and orris, stimulate the gastric mucosa after oral administration, cause slight nausea, reflexively promote the increase of bronchial secretion, make the sputum thin and easy to cough up. Stimulating expectorants are some volatile substances, such as eucalyptus oil and benzoin tincture, whose vapors can stimulate respiratory mucous and increase glandular secretion, making sputum dilute and easy to cough up.
(2) Mucolytic agents: such as N-acetylcysteine can decompose the sticky components of sputum such as mucopolysaccharide and mucin, which can make thick sputum dissolve, reduce viscosity and make it easy to cough up.
(3) Mucus regulators: such as bromohexine, aminobromine, etc., mainly act on the mucus-producing cells of trachea and bronchus to promote their secretion of secretion with low viscosity, so that the rheology of respiratory secretion can be restored to normal and sputum can be changed from viscous to thin and easily coughed out.
1.1 Ammonium chloride: oral administration can stimulate the vagus nerve endings of gastric mucosa, causing mild nausea, reflexively resulting in increased secretion of tracheal and bronchial glands. Part of ammonium chloride is absorbed into the blood and excreted through the respiratory tract, which brings out water at the same time due to the osmotic pressure effect of salts, making the sputum dilute and easy to cough up. It is mostly used in acute and chronic respiratory tract inflammation where sputum is sticky and not easily coughed out. In addition to the expectorant effect, ammonium chloride also has diuretic and acidifying effects on body fluids and urine.
Common adverse reactions of ammonium chloride include nausea, vomiting, stomach pain and other symptoms of gastric mucosa irritation. It is used with caution in patients with hepatic and renal insufficiency, peptic ulcer, and can cause hypoxia in patients with sickle cell anemia. Avoid use in patients with metabolic acidosis and uremia. Overdose and/or long-term use may cause acidosis and hypokalemia. Combination with sulfadiazine and furantoin may create a contraindication to the combination. The drug may reduce the efficacy of pseudoephedrine and methadone, and may enhance the antibacterial effect of tetracycline and penicillin.
Regular dose for children: 40-60mg/kg daily, or 1.5g/m2, administered orally in 4 doses. Take after meals.
1.2 Guaifenesin glycerol ether: It is the most commonly used oral expectorant in the United States and is a nauseating expectorant. It can stimulate the mucous membrane of the gastrointestinal tract to reflexly cause an increase in the secretion of bronchial mucosal glands, reduce the viscosity of sputum, and make the mucous sputum easy to cough up. Guaiacol glycerol ether also has certain antiseptic and anti-inflammatory effects, and also plays a certain diastolic effect on bronchial smooth muscle. It is used for coughs of various causes.
Common adverse effects of guaiacol glycerol ether are nausea, stomach upset, dizziness, drowsiness, etc. It is contraindicated in patients with hypersensitivity to the drug, in patients with pulmonary hemorrhage, in patients with acute gastroenteritis, in patients with nephritis and hyperalgesia.
Guaiacol glycerol ether regular dose for children: 6-12 years old, 0.1-0.2g per dose; 2-6 years old, 0.05-0.1g per dose, 2-3 times daily. Administered orally and taken after meals.
1.3 Bromoxynil: It mainly acts on the cup cells of tracheal and bronchial mucosal glands, on the one hand, it promotes the release of lysosomes and deconglomerates mucopolysaccharides in mucus, which reduces the mucus consistency, but the effect is weak; on the other hand, it makes the cup cells secrete small molecules of mucin with lower viscosity, resulting in the rheological properties of trachea and bronchus returning to normal, the mucus sputum decreasing, and the sputum diluting and easy to cough up. The expectorant effect is also related to its promotion of cilia movement of respiratory mucosa and its nauseating expectorant effect. It is mainly used for patients with chronic diseases of lung or bronchus who have mucous sputum and cannot be easily coughed up.
Mild adverse reactions: gastrointestinal reactions such as stomach upset, nausea, stomach pain, diarrhea, as well as headache and dizziness, etc., may disappear after dose reduction or discontinuation. Serum aminotransferase may increase transiently. Serious adverse reactions: skin rash, enuresis. Use with caution in patients with peptic ulcer. Brodifacoum may increase the distribution concentration of tetracycline antibiotics in the bronchial tubes.
Regular dose for children: under 5 years of age, 4 mg twice a day; over 5 years of age, 4 mg 3-4 times a day; administered orally.
1.4 Ambroxol: It is the active metabolite of bromoxyn, which can enhance the secretion of plasma glands and reduce the secretion of mucus glands in respiratory mucosa; it can break the mucopolysaccharide fibers in sputum so as to dilute sputum and reduce sputum viscosity by inhibiting glycoprotein synthesis; it promotes the secretion of lung surface active substances and enhances the movement of bronchial cilia, so that sputum can be easily coughed out. In addition to expectorant effect, it also has certain cough suppressant effect.
Adverse effects of amiloride include upper abdominal discomfort, poor appetite, diarrhea, and occasionally rash, and rapid intravenous injection has been reported to cause lumbar pain and fatigue in patients. Concurrent administration of strong cough suppressants should be avoided. The injection should not be mixed with other solutions with pH greater than 6.3. Ambroxol enhances the distribution concentration of amoxicillin and amoxicillin clavulanic acid and erythromycin in the lungs, thereby increasing the antibacterial efficacy of the latter. It has synergistic effects when combined with β2 adrenergic agonists, theophylline and other bronchodilators.
Common dosage for children.
Oral solution: over 12 years old, 30mg; 5-12 years old, 15mg; 2-5 years old, 7.5mg; under 2 years old, 7.5mg once, 2-3 times a day. Take after meals, and reduce to 2 times a day for long-term users. Extended-release capsule: based on 1.2~1.6mg/Kg a day.
Intravenous injection: prophylactic treatment of postoperative pulmonary complications: above 12 years old, 15mg, which can be increased to 30mg once in severe cases; 6-12 years old, 15mg; 2-6 years old, 7.5mg; below 2 years old, 7.5mg once, 2-3 times a day. All should be injected slowly.
Intravenous drip: for children over 12 years old, 30mg once, twice a day.
1.5 N-Acetylcysteine: It was first used in the 1960s and is a commonly used clinical expectorant drug, which can dissolve mucus sputum and also purulent sputum. N-acetylcysteine also stimulates the ciliary movement of the respiratory tract and stimulates the gastric-pulmonary vagal reflex, thus promoting mucus clearance. It is mainly used for dyspnea caused by large amount of mucous sputum obstruction, such as acute and chronic bronchitis, bronchial dilatation, tuberculosis, pneumonia, pulmonary edema and surgery, etc., which cause sticky sputum and difficulty in coughing up sputum. It can also be used for the relief of acetaminophen toxicity [8].
Adverse reactions are choking, bronchospasm, nausea, vomiting, gastritis, and rash, which usually resolve with dose reduction. Other adverse reactions such as cardiovascular system, central nervous system, fever, chills, elevated transaminase values, and shortened prothrombin time have been reported. Use with caution in diabetic patients, infants and children. Contraindicated in patients with bronchial asthma and severe airway obstruction, especially nebulized inhalation or intratracheal drip. If bronchospasm occurs, the drug should be stopped immediately and relieved with isoprenaline. Direct drip into the respiratory tract may produce large amounts of sputum, which needs to be drained by suction. Concurrent administration of strong cough suppressants should be avoided. This drug can weaken the antibacterial activity of penicillin, tetracycline and cephalosporins, so it should not be combined with these drugs. Contraindicated with iodized oil, trypsin and chymotrypsin. Its aqueous solution is easy to deteriorate in the air, so it should be configured before use and the remaining solution should be refrigerated and used within 48h. Oral granules can be mixed with a small amount of warm water (below 80℃).
Common dosage for children.
Spray inhalation: In non-emergency cases, spray inhalation with 10% solution, 1~3ml each time, 2~3 times a day.
Tracheal drip: in emergency, 5% solution should be injected into the trachea through the tracheal tube or directly, 1~2ml each time, 2~6 times a day.
Tracheal injection: in first aid, inject 5% solution into the tracheal cavity through the cricoid membrane of the thyroid cartilage of the trachea with a syringe, 0.5ml for infants and 1ml for children each time.
Oral expectoration: 100mg once, 2-4 times a day, increase or decrease according to age as appropriate.
When used for acetaminophen poisoning, the drug is most effective when administered 10-12 hours after poisoning, orally: 140mg/Kg at first, then 70mg/Kg once, 17 times. In severe cases, the drug can be dissolved in 5% glucose injection 200ml and given intravenously.
Suggestions for the administration of expectorants.
It is advisable to identify the cause of cough and sputum first, distinguish the nature of cough and the nature of sputum, and select expectorants in a targeted manner.
Syrup agents should not be used in breastfed infants because sugar can reduce the infant’s interest in breast milk.
Most expectorants can cause nausea and vomiting, so the dosage should not be too large to avoid electrolyte disturbance.
2, cough suppressants: commonly used cough suppressants can be divided into two categories according to the site of action.
(1) Central cough suppressants: directly inhibit the medullary cough center to produce cough suppressant effects, such as dextromethorphan, codeine, pentoxifylline, mostly used for dry cough without sputum.
(2) Peripheral cough suppressants: drugs that suppress the cough by inhibiting any of the cough reflex receptors, afferent nerves, efferent nerves and effectors, such as licorice sulfur infusion.
Dextromethorphan and codeine are the two most commonly used cough suppressants in clinical practice, and are often compounded with expectorants or first-generation antihistamines.
2.1 Dextromethorphan: a central cough suppressant, commonly used as its hydrobromide, acts as a cough suppressant by inhibiting the medullary cough center and is one of the most widely used cough suppressants for the treatment of acute cough caused by upper respiratory tract infections because it is not addictive [9]. The cough suppressant effect of dextromethorphan is similar to or slightly stronger than codeine, and 10 mg of dextromethorphan is equivalent to the cough suppressant effect of 15 mg of codeine [10]. Its therapeutic amount does not inhibit respiration, and long-term administration is desirable without addictive properties. Dextromethorphan is safe as a cough suppressant if formulated properly and administered in small doses, but its abuse can lead to serious adverse events such as brain damage, loss of consciousness, abnormal heartbeat, and even death, so the US Food and Drug Administration (FDA) warned the public in 2005 not to abuse dextromethorphan. Dextromethorphan is primarily used for irritating dry cough and frequent, violent coughs, and is not recommended for chronic coughs or coughs with large amounts of secretions. Dextromethorphan has only a suppressant effect and should be used with attention to the cause of the cough. If symptoms do not resolve within 1 week of administration, further investigation of the cause is required.
The unpleasant effects of dextromethorphan are dizziness and gastrointestinal disturbances. Similar to codeine, it can cause histamine release in sensitive individuals, and at usual doses, its toxic effects are low. At high doses, however, dextromethorphan can cause central nervous system depression. Two cases of adverse reactions have been reported in children with symptoms of ataxia, nystagmus, and disturbance of consciousness; neither case was free of respiratory failure, although the doses administered in these two cases were 9-10 times the usual recommended dose. The drug’s adverse effects can be exacerbated when combined with fluoxetine and paroxetine. Combination with other CNS depressants may enhance the central depressant effect. Combined with opioid receptor antagonists, withdrawal syndrome may occur.
Regular oral dose for children: under 2 years old: the dose is undetermined or as prescribed by the doctor; 2-6 years old: 2.5~5mg once, 3-4 times a day; 6-12 years old, 5-10mg once, 3-4 times a day.
2.2 Codeine (methylmorphine)
Central narcotic cough suppressant, commonly used its phosphate, can directly inhibit the medullary cough center, but also has analgesic effect. It is rapidly and completely absorbed orally, and the duration of cough suppression is 4-6 h. It is used clinically to relieve severe dry cough caused by various reasons, and is especially suitable for severe dry cough with chest pain. Compared with placebo, codeine can reduce the number of coughs by 40%-60% in the treatment of chronic bronchitis or COPD, but it is less effective in coughs caused by acute upper respiratory tract infections.
The more common adverse reactions are psychopathy or fantasy; increased or decreased heart rate and abnormal heart rhythm; slight respiratory depression, euphoria and addiction. Less common adverse reactions are tinnitus, tremor, skin itching, urticaria or angioneurotic edema, and other allergic reactions. High doses can cause convulsions. It is contraindicated in patients with excessive phlegm because it can inhibit the cough reflex, causing large amounts of phlegm to obstruct the airway and aggravate the condition by secondary infection. Use with caution in bronchial asthma, acute abdominal disease, cranial trauma or intracranial lesions. The FDA warns that nursing mothers taking codeine should watch their children for signs of drowsiness and other drug overdose.
2.3 Forcodine.
Forcodine is a central cough suppressant similar to codeine that is readily absorbed through the digestive tract and can freely cross the blood-brain barrier. It acts mainly on the central nervous system to inhibit the cough reflex; it can also act directly on the cough center of the medulla oblongata to selectively inhibit coughing; it also has sedative and very weak analgesic effects. It is mainly used for dry cough. According to foreign data, its central cough suppressant effect is similar to codeine, and it is safer than codeine because it is not converted into morphine in the body and has minimal addiction. Its side effects are rare, mainly dizziness and gastrointestinal disorders (such as nausea or vomiting), and occasionally constipation, drowsiness, euphoria, ataxia and respiratory depression.
Oral dose for children: 6 months to 2 years, 2.5mg per dose; >2 to 6 years, 5mg per dose; over 6 years, 10mg per dose, 3 times a day.
Medication recommendations for cough suppressants.
Cough suppressants should generally be used sparingly in children, and should be disabled in children with excessive sputum or pulmonary bruising.
A small number of children with severe cough or with chest pain and hypertonic pneumothorax may be given cough suppressants, but they must be strictly controlled and applied with caution.
Central cough suppressants with addictive properties, such as codeine and codeine-containing combinations, must be contraindicated in children.
If the effect of cough suppressants in children is not obvious in 3-7 days, further examination should be done to avoid missed diagnosis and misdiagnosis.
3.Nasal decongestants
The pharmacological effect of nasal decongestants is to make the swollen nasal mucosa vasoconstriction, in order to reduce nasal congestion. It can be used to relieve the symptoms of nasal congestion, runny nose and sneezing caused by acute and chronic rhinitis and sinusitis and other upper respiratory tract infections. The method of administration is often topical nasal administration and systemic administration (oral). However, long-term use of nasal decongestants can be complicated by drug rhinitis and nasal mucosal congestion rebound, especially in infants who breathe exclusively through the nose, nasal congestion can be aggravated by previous symptoms, so topical decongestants are used with caution in infants. Currently, pseudoephedrine is the most commonly used oral nasal decongestant in pediatrics.
3.1 Pseudoephedrine: its hydrochloride is commonly used. Indirect sympathomimetic effect mainly through the promotion of norepinephrine release. It can selectively constrict blood vessels, eliminate mucosal congestion and swelling in the nasopharynx, and has a weak effect on heart rate, blood pressure and the central nervous system. Pseudoephedrine hydrochloride is available in various dosage forms, and is now often used in pediatric clinics in combination with antipyretic analgesics (e.g. acetaminophen, ibuprofen), antihistamines (e.g. paracetamol), and cough suppressants (e.g. dextromethorphan) in compound form.
3.2 Cyclozoline hydrochloride: It is a sympathomimetic drug that acts on the a-adrenergic receptors of the nasal mucosa to produce vasoconstriction, thereby reducing blood flow and nasal congestion. The drug is a sympathomimetic agent with a-receptor activity, rapid vasoconstriction, long duration of action, and few side effects. Its nasal drops are mostly used in the market. It is suitable for relieving nasal symptoms caused by acute and chronic rhinitis, sinusitis, allergic rhinitis, hypertrophic rhinitis, etc. Individual patients may have transient burning sensation of nasal mucosa, dryness, headache, dizziness, rapid heart rate, etc., which will disappear immediately after stopping the drug.
Commonly used dose of 0.05% Serozoline Hydrochloride Nasal Drops: For children aged 6-12 years, 2-3 drops on each side, once in the morning and once at bedtime, or more if necessary. Not for use in infants.
Recommendations for the use of nasal decongestants
For common cold or presence of nasal congestion and runny nose, pseudoephedrine containing preparation can be used to relieve nasal congestion and keep the airway open.
4.Antipyretic and analgesic drugs
Antipyretic and analgesic drugs are a class of drugs with antipyretic and analgesic effects, and most of them also have anti-inflammatory and anti-rheumatic effects. Aspirin is the representative of this kind of drugs. All of these drugs have antipyretic and analgesic effects, but their anti-inflammatory effects have different characteristics based on their chemical structures, for example, aspirin has a strong anti-inflammatory effect, while acetaminophen has almost no anti-inflammatory effect. Because of the wide variety of antipyretic and analgesic drugs, dosage forms and trade names, improper use can cause serious harm.
4.1 Aspirin: Acetylsalicylic acid, a long-established antipyretic and analgesic drug, has strong and rapid antipyretic and analgesic effects, as well as anti-inflammatory, anti-rheumatic and anti-thrombotic effects. The most common adverse reactions are gastrointestinal reactions, which can even cause gastric ulcers and gastric bleeding, and damage to liver and kidney functions. The toxic effects of overdose and its specific allergic reaction to salicylic acid are serious or lethal adverse reactions. The use of the drug in children after influenza (flu) or chickenpox may cause Reye’s syndrome, causing a decrease in white blood cells and platelets. As a result, many national health authorities have legislated to withdraw aspirin preparations for children. The World Health Organization advocates that aspirin should not be used in children with acute respiratory infections causing fever, and its use is limited to rheumatic fever, juvenile arthritis and Kawasaki disease in children. Our recommended treatment protocol for atypical pneumonia (SARS) states that aspirin is contraindicated in febrile children.
4.2 Ibuprofen: It has obvious anti-inflammatory, antipyretic and analgesic effects. Its antipyretic and analgesic effects are dose-dependent in the dose range of 5-10 mg/kg, and clinically effective in the dose range of 7.5-10 mg/kg, with the greatest reduction in body temperature 3-4 h after administration. It is another most commonly used antipyretic and analgesic drug with low occurrence of adverse reactions and similar tolerability to acetaminophen when used in regular doses. According to domestic and international studies, ibuprofen is safe, effective and long-lasting in the treatment of hyperthermia in children and is suitable for widespread clinical application in pediatrics, but attention should be paid to overdose and overfrequency.
The common adverse reactions of ibuprofen are gastrointestinal adverse reactions, including dyspepsia, heartburn, stomach pain, nausea and vomiting. Less than 1% of patients have gastric ulcers and gastrointestinal bleeding. 1% to 3% of patients have neurological adverse reactions, such as headache, drowsiness, vertigo, tinnitus, etc. Rare adverse reactions are lower limb swelling, renal insufficiency, skin rash, bronchial asthma, abnormal liver function, and reduced leukemia. Ibuprofen is cross-sensitized with aspirin and is therefore contraindicated in children with aspirin hypersensitivity.
Oral administration for fever: dispersible tablets, suspension: recommended dose 20mg/Kg a day, divided into 3 doses; slow release suspension: 20mg/Kg a day, divided into 2 doses; suspension drops: 5-10mg/Kg a time, repeated when needed for 6-8h, not more than 4 times per 24h. Rectal administration: 50mg once for children aged 1 to 3 years, inserted into the anus, if the symptoms are not relieved, repeat every 6 to 8h, not more than 200mg for 24h. 100mg each time for children aged 3 years or above.
The recommended dose of ibuprofen is 5-10 mg/kg once every 6-8 hours. The United States allows its use in children over 6 months of age.
4.3 Acetaminophen, also known as paracetamol, is a relatively safe antipyretic drug with antipyretic and analgesic effects similar in strength to those of aspirin and almost no anti-inflammatory effects. Adverse effects are rare when the drug is taken in regular doses for short periods of time, but hepatotoxicity may occur if applied in large doses or for longer periods of time [25].
Some studies suggest that acetaminophen can be used at a single loading dose of 30 mg/kg or even up to 40 mg/kg, but it is not very clear whether the use of higher doses leads to better therapeutic effects. Therefore, most of the literature supports a maximum single dose of 10-15 mg/kg. pharmacokinetics suggest that rectal administration is less bioavailable than oral dosing, but rectal administration of 15 mg/kg is similar to oral administration of the same dose of acetaminophen, so there is no reason to choose a higher dose. Based on numerous previous studies, acetaminophen should not be administered to febrile children in single doses greater than 75 mg?kg-1?d-1, if children with febrile illness receive doses greater than this or total doses greater than 150 mg/kg, or if children develop nausea, abdominal pain, or jaundice requiring immediate liver function testing.
Nausea, vomiting, sweating, and abdominal pain are occasionally seen with regular doses of acetaminophen; allergic dermatitis, granulocyte deficiency, and thrombocytopenia may occur in a few patients. Adverse reactions are usually associated with high doses of long-term use, overdose, or with abnormalities such as hepatic or renal insufficiency. Allergy to aspirin does not usually occur, but mild bronchospastic reactions may occur in less than 5% of aspirin-allergic patients taking the drug. Contraindicated in severe hepatic and renal insufficiency. Use with caution in patients with liver disease or viral hepatitis, mild to moderate hepatic or renal insufficiency, severe cardiopulmonary disease, and glucose-6-phosphate dehydrogenase deficiency.
Regular dose: administered orally, 10-15mg/Kg once, or 1.5g/m2 once a day, once every 4-6 h. Not more than 5 times every 24 h for children aged 3-12 years, for a course of treatment not exceeding 5 d.
4.4 Anacin: Its mechanism of antipyretic and analgesic action is similar to that of ibuprofen, but it can produce more adverse reactions, mainly nephrotoxicity, gastrointestinal bleeding, severe rash, allergic reaction, lethal granulocyte deficiency and aplastic anemia. Oral administration of anandamide has been rarely used. Because it was mostly administered by intramuscular injection in the past, it can cause redness, swelling and pain at the injection site, and improper use may even cause muscle atrophy in the buttocks of children, and repeated intramuscular injection may also cause anxiety and fear in children so that they do not cooperate with the doctor’s treatment. At present, there are still hospitals using 10% to 20% solution nasal drops, children aged 5 to 6 years are generally not given nasal drops, to ensure the safety of the drug can only be used once. The most serious side effect of Anacin is lethal granulocyte deficiency, which was discontinued in the United States in 1977 and is currently banned or restricted in 27 countries. However, it is still used in some local hospitals in China, which should be given high priority [24].
4.5 Nimesulide: Its antipyretic and analgesic effects and anti-inflammatory effects are strong. However, the drug can cross-paradoxical reactions with aspirin and other NSAIDs, and it is prohibited for those who are allergic to acetylsalicylic acid or other NSAIDs. The use of this drug in pediatrics was banned in Portugal in 1999 due to a number of serious adverse reactions in pediatric therapeutic applications. And due to reports of serious side effects affecting the liver, the Irish pharmacy authorities terminated the authorization of all nimesulide containing preparations on May 27, 2007. Shortly thereafter, the Singapore Health Authority and the health authorities in Taiwan also took steps to terminate or restrict the use of nimesulide containing preparations. In June of the same year the European Medicines Agency (EMEA) began an evaluation of the hepatic safety of nimesulide preparations and recommended that treatment with nimesulide should be limited to a maximum of 5 d; all packages with dosages exceeding 15 d needed to be withdrawn from the market. Physicians are advised to prescribe nimesulide for individual patients on the basis of an overall risk evaluation. The FDA has revised the instructions for use of Nimesulide to include a black box warning that this drug can indeed cause liver failure. The safety of this drug has not yet received sufficient attention in our pediatric clinics, so with effective and safer antipyretic drugs available, Nimesulide should not be used as the drug of choice for reducing fever.
Recommendations for the use of antipyretic and analgesic drugs.
(a) Antipyretic and analgesic drugs are symptomatic treatment, and sometimes the diagnosis can be affected by the use of drugs that mask the symptoms, so they should be used with caution in children with unknown diagnosis.
Choose dosage forms with low toxicity, few adverse reactions and easy acceptance by children, and do not recommend the use of injections for children. The antipyretic analgesics currently considered most suitable for use in children are acetaminophen and ibuprofen
Simultaneous administration of multiple antipyretic analgesics should be avoided, and alternate dosing may be used to reduce fever and increase antipyretic efficacy.
calculate the dosage according to the child’s age and weight to avoid overdosing or over-frequency.
long-term application of such drugs should be avoided in children and the course of treatment should not be > 1 week
Glucocorticoids should not be abused to reduce fever, because they have immunosuppressive effects and their improper use may aggravate the disease by promoting the spread of bacterial or viral infections. Glucocorticosteroids should not be misused to reduce fever because they have immunosuppressive effects and their inappropriate use may aggravate the spread of bacterial or viral infections.