Paracetamol and Ibuprofen in the Treatment of Fever and Acute Mild–Moderate Pain in Children: Italian Experts’ Consensus Statements

Abstract

Fever and pain are challenging symptoms in children and adolescents and are common reasons for consultations in primary care and hospital. Paracetamol and ibuprofen are currently the only recommended drugs for treating fever in Italy, but the therapeutic approaches are discrepant in the different settings. In Italy, paracetamol and ibuprofen are the most prescribed analgesics for acute mild–moderate pain in children; however, their use is often inappropriate in that fever is over-treated and pain is under-treated. An Italian board of experts analyzed the motivations for the misalignment between daily practice and guidelines of fever and acute mild–moderate pain management of the territory and hospitals. The expert opinion consensus process underscored the appropriate use of paracetamol and ibuprofen according to clinical scenarios, patients’ profiles, and the safety features of the drugs. Although patients’ profiles can indicate different benefits from paracetamol or ibuprofen, critical issues of fever and acute mild–moderate pain management persist in primary care and hospitals. These expert opinion consensus statements can be an across-the-board tool to harmonize the routine practice between the territory and hospitals, especially under special conditions (at-risk for dehydration, coagulation disorder patients, etc.). It can also promote educational activity about fever and acute mild–moderate pain management to enhance the milestones already achieved by Italian pediatricians.

Paracetamol and ibuprofen combination for the management of acute mild-to-moderate pain in children: expert consensus using the Nominal Group Technique (NGT)

“…National and international guidelines for the management of pain in children [ 1 , 4 ] were also reviewed. The analysis also focused on even more critical aspects related to the use of ibuprofen and paracetamol in clinical practice: pain undertreatment, appropriateness of dosage regimen, compliance with guidelines by healthcare professionals, and parents [ 10 , 11 ].…”

Pain therapy in the pediatric population

“…Jego stosowanie jest zalecane w wielu przypadkach , szczególnie możliwych do zastosowania w warunkach domowych i ambulatoryjnych z czego najczęstszym jest łagodzenie gorączki, szczególnie ze współistniejącym odwodnieniem . [7] Jest dostępny do podania zarówno w formie doustnej jak i dożylnej i doodbytniczej. Standardowa zalecana dawka doustna tj.…”

“…około 15 mg/kg, jest dawką dobrze tolerowaną z bardzo małym odsetkiem działań niepożądanych. [1], [7] Paracetamol może być stosowany jako jedyny lek w łagodzeniu bólu jednak częstą i skuteczną praktyką, szczególnie przy bólu o większym nasileniu, jest jego łączenie z NLPZ, metamizolem, a w niektórych sytuacjach także przy podaży opioidów. Paracetamol jest lekiem dostępnym bez recepty w preparatach zarówno łączonych jak i występujący samodzielnie w różnym stężeniach.…”

Pain Management in Children Admitted to the Emergency Room: A Narrative Review

“…Generally, a lower dose is given to infants, although these subjects could receive a higher dose, as the clearance of the drug is 98% of adult levels by 3 months of age [ 84 ]. In children >40 kg, 200–400 mg every 8 h with a maximum of 1600 mg/day are recommended [ 85 , 86 , 87 , 88 ]. The development of IB toxicity is uncommon for doses less than 100 mg/kg ingested over the total course of treatment.…”