Medline ® Abstracts for References 1-4
of 'Patient education: Fever in children (Beyond the Basics)'
Management of fever without source in infants and children.
Ann Emerg Med. 2000;36(6):602.
Twenty percent of febrile children have fever without an apparent source of infection after history and physical examination. Of these, a small proportion may have an occult bacterial infection, including bacteremia, urinary tract infection (UTI), occult pneumonia, or, rarely, early bacterial meningitis. Febrile infants and young children have, by tradition, been arbitrarily assigned to different management strategies by age group: neonates (birth to 28 days), young infants (29 to 90 days), and older infants and young children (3 to 36 months). Infants younger than 3 months are often managed by using low-risk criteria, such as the Rochester Criteria or Philadelphia Criteria. The purpose of these criteria is to reduce the number of infants hospitalized unnecessarily and to identify infants who may be managed as outpatients by using clinical and laboratory criteria. In children with fever without source (FWS), occult UTIs occur in 3% to 4% of boys younger than 1 year and 8% to 9% of girls younger than 2 years of age. Most UTIs in boys occur in those who are uncircumcised. Occult pneumococcal bacteremia occurs in approximately 3% of children younger than 3 years with FWS with a temperature of 39.0 degrees C (102.2 degrees F) or greater and in approximately 10% of children with FWS with a temperature of 39.5 degrees C (103.1 degrees F) or greater and a WBC count of 15, 000/mm(3) or greater. The risk of a child with occult pneumococcal bacteremia later having meningitis is approximately 3%. The new conjugate pneumococcal vaccine (7 serogroups) has an efficacy of 90% for reducing invasive infections of Streptococcus pneumoniae. The widespread use of this vaccine will make the use of WBC counts and blood cultures and empiric antibiotic treatment of children with FWS who have received this vaccine obsolete.
Department of Pediatrics and Emergency Medicine, University of California, Los Angeles Emergency Medicine Center, Los Angeles, CA, USA. firstname.lastname@example.org
Fever: blessing or curse? A unifying hypothesis.
Ann Intern Med. 1994;120(12):1037.
Considerable data indicate that fever and its mediators have the capacity both to potentiate and to inhibit resistance to infection. It is difficult to reconcile these apparently contradictory observations if they are viewed solely from the standpoint of the individual. However, when viewed from the perspective of the species, both fever's salutary effects on mild to moderately severe infections and its pernicious influence on fulminating infections become teleologically plausible. If one accepts preservation of the species, rather than survival of the individual, as the essence of evolution, fever and its mediators might have evolved as mechanisms both for accelerating recovery of individuals from localized or mild to moderately severe systemic infections in the interest of continued propagation of the species and for hastening the elimination of fulminantly infected individuals who pose a threat of epidemic disease to the species.
Department of Veterans Affairs Medical Center, Baltimore, Maryland.
Paracetamol for treating fever in children.
Meremikwu M, Oyo-Ita A
Cochrane Database Syst Rev. 2002;
BACKGROUND: Paracetamol (acetaminophen) is widely used for treating fever in children. Like ibuprofen, aspirin, and physical methods (such as fanning), paracetamol aims to provide relief from symptoms and prevent febrile convulsions. Uncertainty exists about the benefits of using it to treat fever in children.
OBJECTIVES: To assess the effects of paracetamol for treating fever in children in relation to fever clearance time, febrile convulsions, and resolution of associated symptoms.
SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group specialized trials register (November 2001), The Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2001), MEDLINE (1966 to November 2001), EMBASE (1988 to November 2001), LILACS (2001, 40a Edition CD-ROM), Science Citation Index (November 2001), and reference lists of articles. We also contacted researchers in the field.
SELECTION CRITERIA: Randomized and quasi-randomized trials of children with fever from infections comparing: (1) paracetamol with placebo or no treatment; and (2) paracetamol with physical cooling methods (eg, sponging, bathing, or fanning). The primary outcomes were fever clearance time and febrile convulsion.
DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data on methods, types of participants, interventions, and outcomes. The meta-analysis was conducted using Relative Risk with 95% confidence intervals for discrete variables, and weighted mean differences for continuous outcomes.
MAIN RESULTS: 12 trials (n = 1509 participants) met the inclusion criteria. Outcomes varied between trials. No data were available on the primary outcome. There is insufficient evidence to show whether paracetamol influenced the risk of febrile convulsions. In a meta-analysis of two trials (n = 120), the proportion of children without fever by the second hour after treatment did not differ significantly between those given paracetamol and those sponged (Relative Risk 1.84; confidence interval 0.94 to 3.61, random effects model). The statistical test showed significant heterogeneity between the groups receiving paracetamol or physical methods. No severe adverse events were reported. The number of children with mild adverse events did not differ significantly between paracetamol and placebo, or paracetamol and physical methods, but numbers were small.
REVIEWER'S CONCLUSIONS: Trial evidence that paracetamol has a superior antipyretic effect than placebo is inconclusive. There is limited evidence that there is no difference between the antipyretic effect of paracetamol and physical methods. Data on adverse events in these trials were limited. Establishing standard outcomes willhelp comparisons between studies and meta-analysis.
Department of Paediatrics, University of Calabar, PMB 1115, Calabar, Cross River State, Nigeria. email@example.com
Antipyretic treatment in young children with fever: acetaminophen, ibuprofen, or both alternating in a randomized, double-blind study.
Sarrell EM, Wielunsky E, Cohen HA
Arch Pediatr Adolesc Med. 2006;160(2):197.
OBJECTIVE: To compare the antipyretic benefit of acetaminophen or ibuprofen monotherapy with an alternating regimen of both drugs in young children aged 6 to 36 months.
DESIGN: Randomized, double-blind, parallel-group trial.
SETTING: Three primary pediatric community ambulatory centers in central Israel.
PARTICIPANTS: A total of 464 children aged 6 to 36 months with fever.
INTERVENTION: Infants were assigned to receive either acetaminophen (12.5 mg/kg per dose every 6 hours) (n = 154) or ibuprofen (5 mg/kg per dose every 8 hours) (n = 155) or to receive alternating acetaminophen and ibuprofen (every 4 hours) (n = 155) for 3 days after a loading dose.
MAIN OUTCOME MEASURES: Temperature, stress score,amount of antipyretic received, total days that the infant or caregiver was absent from day care or work, respectively, at the 3-day time point, recurrence of fever, and number of emergency department visits.
RESULTS: The group given the alternating regimen was characterized by a lower mean temperature, more rapid reduction of fever, receiving less antipyretic medication, less stress, and less absenteeism from day care as compared with the other groups; all of the differences were statistically significant (P<.001). None of the regimens were associated with a significantly higher number of emergency department visits (P = .65) or serious long-term complications (P = .66). The drug used for initial loading had no effect on outcome in any of the groups.
CONCLUSIONS: An alternating treatment regimen of acetaminophen (12.5 mg/kg per dose) and ibuprofen (5 mg/kg per dose) every 4 hours for 3 days, regardless of the initial loading medication, is more effective than monotherapy in lowering fever in infants and children.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. firstname.lastname@example.org