Comparison of Oral Versus Normal and High-Dose Rectal Acetaminophen in the Treatment of Febrile Children

Scolnik, Dennis; Kozer, Eran; Jacobson, Sheila; Diamond, S; Young, Nancy L.

doi:10.1542/peds.110.3.553

Cited by 43 publications

(31 citation statements)

References 23 publications

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“…Although alternative dosing regimens have been suggested, [41][42][43] no consistent evidence has indicated that the use of an initial loading dose by either the oral (30 mg/kg per dose) or rectal (40 mg/kg per dose) route improves antipyretic efficacy. The higher rectal dose is often used in intraoperative conditions but cannot be recommended for use in routine clinical care.…”

Section: Acetaminophenmentioning

confidence: 99%

Fever and Antipyretic Use in Children

Sullivan¹,

Farrar²

2011

Pediatrics

363

313

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Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a “normal” temperature. Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child's overall comfort rather than focus on the normalization of body temperature. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized. Current evidence suggests that there is no substantial difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever. There is evidence that combining these 2 products is more effective than the use of a single agent alone; however, there are concerns that combined treatment may be more complicated and contribute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices.

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Section: Acetaminophenmentioning

confidence: 99%

Fever and Antipyretic Use in Children

Sullivan¹,

Farrar²

2011

Pediatrics

363

313

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“…After proper lubrication, the nurse inserted the suppository beyond the internal sphincter. 23 For oral route, syrup containing 120 mg/5mL of acetaminophen was used. The dose was calculated in mg and was then converted to mL.…”

Section: Introductionmentioning

confidence: 99%

Comparação da eficácia de doses iguais de acetaminofeno retal e oral em crianças

Karbasi¹,

Modares-Mosadegh²,

Golestan³

2010

J. Pediatr. (Rio J.)

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Objective: To compare a dose of oral and rectal acetaminophen and to evaluate acceptability of rectal acetaminophen, since oral and rectal acetaminophen is widely used as an antipyretic agent in febrile children and the comparative effectiveness of these two preparations is not well established. Methods:In this prospective parallel group designed study, 60 children who presented to the emergency department or outpatient pediatric clinic at a tertiary hospital and aged from 6 months to 6 years with rectal temperature over 39 °C were enrolled. Patients were randomly assigned to two equal-sized groups. Group 1 received 15 mg/kg acetaminophen rectally and group 2 received the same dose orally. Temperature was recorded at baseline and 1 and 3 hours after drug administration. Results:In the first group, mean decrease in temperature, 1 and 3 hours after administration of acetaminophen was 1.07±0.16 (p < 0.001) and 1.74±0.25 °C (p < 0.001), respectively, and in the second group it was 1.98±0.19 (p < 0.001) and 1.70±0.14 °C (p < 0.001), respectively (p > 0.05). Conclusion:Rectal and oral acetaminophen preparations have equal antipyretic effectiveness in children. The rectal route proved to be as acceptable as the oral one among parents. J Pediatr (Rio J). 2010;86(3):228-232:Oral acetaminophen, rectal acetaminophen, fever.

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“…On average, about 50% of rectal acetaminophen will bypass the liver [8]. Because of reduced efficacy due to poor absorption and the risk of cumulative toxicity due to high or frequent doses, even American Academy of Paediatrics (AAP) has recommended that suppository be used only for oral intolerance cases like as vomiting [7][8][9]. In a meta-analysis, published by Goldstein et al [10] in 2008, it was found that there was no difference in oral and rectal acetaminophen antipyretic effects [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…In a study by Leary et al on 38 children aged 2 to 54 months, it was found that oral acetaminophen (60 mg for children under one year of age and 120 mg for children older than one year) was more effective than rectal enema with a similar dose in controlling children's fever. They recommended that acetaminophen be administered orally to control fever in children [9][10][11]. Scolnik et al [9] showed no significant difference between the temperatures decrement (the maximum drop in temperature or final temperature or in temperature change during the 3 hours after administration) in children 6 months to 6 years of age treated with 15 mg/kg oral acetaminophen and the same or double dose rectally [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…They recommended that acetaminophen be administered orally to control fever in children [9][10][11]. Scolnik et al [9] showed no significant difference between the temperatures decrement (the maximum drop in temperature or final temperature or in temperature change during the 3 hours after administration) in children 6 months to 6 years of age treated with 15 mg/kg oral acetaminophen and the same or double dose rectally [7][8][9]. Similarly, in a study by Vernon et al on 37 children aged 3 months to 6 years, no difference in antipyretic effects of oral and rectal acetaminophen at a dose of 15 mg/kg was observed.…”

Section: Introductionmentioning

confidence: 99%

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Acetaminophen in Children: Which Dosage, Which Route?

Hashemian¹

2017

J Infect Dis Med

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Fever is one of the most common symptoms among children, which worries parents and makes them go to physicians or emergency centers. One way to control the fever is to administer acetaminophen. Limited studies have been done on the dosage and route of administration of acetaminophen in children. This paper is a review of the correct use of acetaminophen in children based on existing randomized clinical trial studies and with emphasis on dosage and route of administration.

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Comparison of Oral Versus Normal and High-Dose Rectal Acetaminophen in the Treatment of Febrile Children

Cited by 43 publications

References 23 publications

Fever and Antipyretic Use in Children

Fever and Antipyretic Use in Children

Comparação da eficácia de doses iguais de acetaminofeno retal e oral em crianças

Acetaminophen in Children: Which Dosage, Which Route?

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