Rectal Diclofenac Versus Rectal Paracetamol: Comparison of Antipyretic Effectiveness in Children

Abstract

BackgroundFever is the most common complaint in pediatric medicine and its treatment is recommended in some situations. Paracetamol is the most common antipyretic drug, which has serious side effects such as toxicity along with its positive effects. Diclofenac is one of the strongest non-steroidal anti-inflammatory (NSAID) drugs, which has received little attention as an antipyretic drug.ObjectivesThis study was designed to compare the antipyretic effectiveness of the rectal form of Paracetamol and Diclofenac.Patients and MethodsThis double-blind controlled clinical trial was conducted on 80 children aged six months to six years old. One group was treated with rectal Paracetamol suppositories at 15 mg/kg dose and the other group received Diclofenac at 1 mg/kg by rectal administration (n = 40). Rectal temperature was measured before and one hour after the intervention. Temperature changes in the two groups were compared.ResultsThe average rectal temperature in the Paracetamol group was 39.6 ± 1.13°C, and 39.82 ± 1.07°C in the Diclofenac group (P = 0.37). The average rectal temperature, one hour after the intervention, in the Paracetamol and the Diclofenac group was 38.39 ± 0.89°C and 38.95 ± 1.09°C, respectively (P = 0.02). Average temperature changes were 0.65 ± 0.17°C in the Paracetamol group and 1.73 ± 0.69°C in the Diclofenac group (P < 0.001).ConclusionsIn the first one hour, Diclofenac suppository is able to control the fever more efficient than Paracetamol suppositories.

Efficacy and Safety of NSAIDs in Infants: A Comprehensive Review of the Literature of the Past 20 Years

“…An overview on the efficacy and safety of oral and rectal diclofenac is given in Table 6 [ 42 , 244 , 288 – 290 ]. It was consistently shown that children and infants will not benefit from doses higher than 1 mg/kg [ 38 , 43 ].…”

“…showed that effective antipyresis was achieved with 2 mg/kg diclofenac administered intramuscularly, and that infants < 24 months of age had a more rapid onset of antipyresis compared with children <60 months of age [ 289 ]. Rectal diclofenac provided more effective antipyresis compared with rectal acetaminophen in children aged 1–6 years [ 290 ] and can be used for children suffering from vomiting or patients being on nihil per os’ status [ 292 ]. In the postoperative setting, rectal diclofenac allowed earlier solid intake in children aged 3–14 years after tonsillectomy, suggesting an anti-inflammatory effect compared with acetaminophen [ 288 ].…”

“…Infants ≤ 24 months had a more rapid onset of antipyresis compared with children ≥ 60 months (64.5 ± 23.9 vs. 80.4 ± 25.1 min). No allergic reactions or asthma reported Effective antipyresis was achieved with 2 mg/kg diclofenac IM Infants had a more rapid onset of antipyresis Sharif et al [ 290 ] N = 40; 3.17 ± 1.41 years (mean ± SD); range 1–6 years Double-blind, randomized, controlled (acetaminophen) Fever > 38°C for < 4 days; 1 h 1 mg/kg, single dose, rectal Temperature reduction after diclofenac (1.43 ± 0.69 °C) was significantly greater than after acetaminophen (0.65 ± 0.17 °C) 1 h after drug administration ( p < 0.001) No drug-related allergic reactions Diclofenac was more effective in fever reduction than acetaminophen Ketorolac Keidan et al [ 327 ] N = 57 Ketorolac group: n = 25 (4.3 ± 2.6) years (mean ± SD), range 1.7–10 years Prospective, randomized, double-blind Intraoperative analgesia for ambulatory adenoidectomy and tonsillectomy, follow-up 48 h 1 mg/kg IV, single dose Incidence of postoperative nausea and vomiting was low and equal in both groups (propofol and dexamethasone were used for prophylaxis). Postoperative pain scores were equal at all stages of follow-up.…”