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Not sure that I understand the rational for using NSAID's for the
management of fever per se. In the management of fever whenever
possible the underlying cause of the fever should be identified and
treated first. It is not clear if there is any benefit in treating fevers
lower than 41oC. Antipyretics have been given to febrile children but
studies have shown that such treatment did not necessarily improve their
comfort and might even prolong infection. It has also been suggested
that in severe infection the use of antipyretics might increase mortality.
WHO recommends that in developing countries antipyretics should not be
given routinely to children with fever. They should be reserved for
severe discomfort or high fever.
In terms of the management of pain then there is a huge literature, but
the simple question must again relate to the rationale for using an
anti-inflammatory agent.
In general paracetamol would probably be my first choice, the use of
aspirin is not common now because of the association with Reye's
syndrome. Ibuprofen is sometimes used when an alternative is required.
It seems to be effective, but there is little formal experience of its
efficacy and safety. Anecdotal evidence suggests that there may be more
associated bronchospasm in susceptible patients (asthmatics) with
mefenamic acid.
Drwal-Klein & Phelps. Antipyretic therapy in the febrile child. Clin Pharm
1992;11:1005-21
Kramer et al. Risks and benefits of paracetamol antipyresis in young
children with fever of presumed viral origin. Lancet 1991;337:591-4
Doran et al Acetominophen: more harm than good for chickenpox? J
Pediatr 1989; 114: 1045-8
Shann F Antipyretics in severe sepsis. Lancet 1995; 345: 338
Hope this helps.
Tim Dodd
Director of Pharmacy
Shaukat Khanum Memorial Cancer Hospital
Lahore, Pakistan
timdodd@brain.net.pk
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