E-drug: Diclofenac and mefenamic acid (cont'd)
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Regarding the management of fever in children, a booklet was created
that summed up information obtained from various international sources;
among these were web sites, recent studies, and reference texts. What
was found is that, as others have already mentioned, paracetamol
(acetaminophen) is the safest antipyretic available for children.
Ibuprofen is an alternative, but it is not considered safe by all
countries. If it would be helpful, the internet address is:
http://www.irfmn.mnegri.it/mrpm/
The use of diclofenac and mefenamic acid in children for fever is not
very common, this was shown by the few results obtained when we
consulted Medline. The only 3 refereces found were:
1. Cedrato AE., Passarelli I, Cimollini L., Maccarone H.
Comparison of the antipyretic effect of a single dose of
dipyrone, paracetamol and diclofenac resinate. A multicenter
clinical trial (letter). Medicina 49 (6): 635-6, 1989.
2. Polman HA., Huijbers WA. The use of diclofenac sodium
(voltaren) suppositories as an antipyretic in children with
fever due to acute infections: a double blind,
between-patient, placebo-control study. Journal of
International Medical Research. 9(5):343-8. 1981
3. Dittmer A. Body temperature and fever -- body
temperature regulation, indications and possibilities of
fever-reducing therapies. II. Indications and effects of
fever-lowering procedures and fever-reducing drug therapy.
Kinderarzliche Praxis. 49(3):113-21. 1981 Mar.
The Micromedex Drug Information System states that mefenamic acid
"is not suggested in children less than 14 years old, however, it has
been given in antipyretic doses of 6.5 milligrams/kilogram/dose and 3
milligrams/kilogram/dose. Both doses were equally effective as the
customary aspirin antipyretic dose (Weiss, et. al. 1968)." As for
diclofenac (suppositories), the Micromedex system refers to Polman's
study (see above), suggesting that in the doses of 25 milligrams for
children age 2 to 5 years and of 50 milligrams for children age 6 to 10
years, it was effective in reducing fever due to viral or bacterial
infections in 43 patients.
In Italy, both diclofenac (Voltaren) and mefenamic acid are not
indicated for antipyretic use. Furthermore, the overall use of
diclofenac is not recommended for children less than 14 years of age.
Alessandra Corsetti, Chiara Pandolfini and Maurizio Bonati
Laboratory for Mother and Child Health
The Mario Negri Institute for Pharmacological Research (Milano)
MOTHER_CHILD@irfmn.mnegri.it
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