Recently, I read an article in Bao’er’s mother’s WeChat about: the process of children’s medical treatment in Australia, specifically pointing out that the use of pediatric antipyretics in Australia is preferred to acetaminophen, i.e. paracetamol, rather than ibuprofen, i.e. Merlin, Tencel, etc. Australian doctors pointed out that ibuprofen is not safe for pediatrics, it will cause kidney damage, especially due to diarrhea-induced fever, if in a state of dehydration caused by kidney damage is also more serious, and even irreversible, often parents themselves are not able to correctly determine whether the baby is in a state of dehydration, so take this medicine to reduce fever is quite dangerous! Is this the case? I looked up the relevant information, studied well again, and organized a little about the choice and use of pediatric antipyretics. First of all, we know that fever is mostly a common symptom caused by viral, bacterial and other infections or other non-infectious causes. Increased body temperature is a natural defense response of the body, which can lead to increased synthesis and phagocytic activity of the organism, and sometimes helps in diagnosis and healing. However, persistent high fever (axillary temperature >39℃) in children not only increases oxygen consumption and the metabolism of various nutrients, but also causes complications such as convulsions. Therefore, the appropriate application of antipyretic drugs is necessary. Foreign studies have confirmed that parents have a general fear of fever in children and are prone to inappropriate use of antipyretics, which in turn can have a negative impact on the child’s health. The main ingredients of oral medications currently on the market for fever reduction are acetaminophen, ibuprofen, and nimesulide. Most parents and friends already know that on May 20, 2011, the State Food and Drug Administration announced that it would adjust the clinical use of “Nimesulide (Riziqing)”, based on the monitoring report of adverse reactions to the oral preparation, domestic and international research and regulatory situation and expert opinions. The clinical use of “Nimesulide” is prohibited for children under 12 years old. For acetaminophen and ibuprofen as the main ingredients of antipyretic drugs, they are over-the-counter drugs, relatively safe, how to choose? Let’s understand it first. 1, acetaminophen (paracetamol) representative drugs: Tylenol, pediatric Benadryl, acetaminophen suppositories. Acetaminophen belongs to the non-steroidal anti-inflammatory drugs, is the metabolite of finasteride, through the inhibition of cyclooxygenase, selective inhibition of hypothalamic thermoregulatory center prostaglandin synthesis, resulting in the expansion of peripheral blood vessels, sweating and achieve the effect of antipyretic. It is recommended by the World Health Organization (WHO) as the drug of choice for fever in infants and children aged >2 months because of its rapid onset of action, strong effect and safety. The drug is rapidly and completely absorbed and produces antipyretic effect within 30 minutes of oral administration, but the time to control body temperature is relatively short, 2 to 4 hours. In regular doses, its adverse reactions are rare, occasionally can cause nausea, vomiting, abdominal pain, skin pallor, etc. A few cases can occur allergic dermatitis (rash, skin itching, etc.), granulocyte deficiency, thrombocytopenia, anemia, liver and kidney function damage, etc., rarely cause gastrointestinal bleeding; long-term heavy use can lead to abnormal liver and kidney function, but also increase the incidence of asthma in infants. 2013 FDA (U.S. The FDA (U.S. Food and Drug Administration) had a safety notification: acetaminophen can cause rare but serious skin reactions. Skin redness, rash, blistering, and superficial skin peeling may occur. And such reactions can occur at the first use/any time. 2.Ibuprofen representative drugs: Tencel, Merlin, ibuprofen suppository. Ibuprofen is also a non-steroidal anti-inflammatory drug, an inhibitor of cyclooxygenase, inhibits prostaglandin E2 synthesis, and has the effect of inhibiting the release of tumor necrosis factor. Its antipyretic effect is achieved by inhibiting the synthesis of hypothalamic prostaglandins, stimulating posterior pituitary vasopressin and melanocyte estrogen, increasing the heat dissipation process, and shifting the regulation point of the central temperature to achieve the antipyretic effect. The average duration of controlled antipyretic time is about 6 hours, up to 8 hours, and the effect of antipyretic for high fever above 39℃ is better than that of acetaminophen. However, ibuprofen has mild gastrointestinal discomfort, occasional rash and tinnitus, headache, affects coagulation and elevated transaminases, etc. It has also been reported to cause gastrointestinal bleeding and aggravate ulcers, as well as occasional reversible renal injury in states of dehydration, low blood volume and low cardiac output as mentioned in the article. Renal papillary necrosis and acute renal insufficiency may occur in some susceptible individuals with underlying nephropathy. Overdose may have side effects such as central nervous system symptoms and seizures. The above briefly describes the pharmacological effects and side effects of these two types of drugs. We also understand that so far, WHO and FDA recommend acetaminophen and ibuprofen as safe and effective antipyretics for pediatric use. The following summarizes what to pay attention to when choosing medication? 1, the text says there is no specific fever to how many degrees to eat antipyretic drugs. It should be based on the specific situation of the child, such as the presence of mental depression, lethargy, drowsiness and other conditions should take antipyretic drugs. If the child is in good spirits and plays normally, there is no rush to apply antipyretics. However, some pediatric tools still propose to give physical cooling below 38.5℃: such as keeping the room quiet, air circulation, shade; drinking more water; 28~30 degree water or 30%~50% ethanol rubbing bath. Above 38.5℃, choose oral antipyretics. Because the child is young can not express their feelings; some other children with a history of febrile convulsions family members will feel, the child’s body temperature rises rapidly, no mental state changes such as mental lethargy, and a good moment on the occurrence of convulsions. The risk of febrile convulsions increases when the body temperature exceeds 38.5°C. Therefore, choose oral antipyretics for body temperature above 38.5℃. 2.Physical cooling is advocated for infants under 3 months of age with fever, and drug cooling is not advocated. 3. Oral antipyretics can generally be taken once every 4-6 hours, no more than 4 times a day; they should be taken after meals as much as possible and should not be given on an empty stomach to avoid stimulation of the gastrointestinal tract by drugs. 4, when taking drugs should drink more water, timely replenishment of electrolytes, in order to facilitate sweating and cooling, to prevent the occurrence of deficiency. Repeated use of antipyretic drugs should be rechecked to detect whether the granulocyte count is reduced. 5, try to use an antipyretic drug, combined use should pay attention to the indications. Acetaminophen is recommended by the World Health Organization for fever in children aged 2 months to 5 years. Compared to ibuprofen, it has fewer adverse reactions and no stimulation of the gastrointestinal tract. Use ibuprofen with caution in children younger than 6 months of age. For severe and persistent fever, it is recommended that the two be taken alternately (because acetaminophen lasts 2 to 4 hours and ibuprofen lasts 6 to 8 hours). 6. Acetaminophen is most afraid of encountering alcohol, even alcoholic beverages / patchouli and other alcohol-containing drugs. If its encounter with alcohol can lead to liver failure, or even death.