A study on evaluation of prescription pattern of drugs in upper respiratory tract infections in children at a tertiary care hospital

Background: Acute respiratory tract infections (ARTIs) are a major burden to child health in developing countries like India. Preschool children have 4–8 episodes of the upper respiratory tract infection (URTI) per year on average, while school-aged children experience 2–6 episodes per year. They are the most prevalent reason for visits to the outpatient section of a hospital and general practice. Aim and Objective: The aim of this study was to evaluate the prescribing patterns in patients aged 1–18 years with URTIs. Materials and Methods: A prospective study conducted in the department of pharmacology at a tertiary health care center. Two hundred and fifty patients with URTI visiting pediatric and ENT department of tertiary health care center during December 2014–June 2015 were studied. Data included detailed history, physical examination, investigations, antimicrobial treatment given, and other treatment given were noted. This data was gathered from the records of Pediatric and ENT department. Statistical tests were used to analyze the data. Results: The most common clinical presentation was fever and cough. The common diagnosis noted in the study were non-specific URTI, tonsillitis, and sinusitis. Antipyretics (99.6%) and antibiotics (52%) were the frequently prescribed drugs among the patients. Amoxicillin-clavulanic acid and cephalosporins were the common antibitoics prescribed. Beta-hemolytic streptococci were the common microbe isolated among the patients tested to know the etiology. Conclusion: Antipyretics (99.6%) and antibiotics (52%) were the frequently prescribed drugs among the patients. Antibiotics were prescribed in most of the non-specific URTI and pharyngitis which is a matter of concern.

Real world evidence of the use of metamizole (dipyrone) by the Brazilian population. A retrospective cohort with over 380,000 patients

ABSTRACT Objective To determine under which health conditions metamizole (dipyrone) is used as a single drug or as fixed-dose combination. Methods Two retrospective cohorts of Brazilian patients treated with metamizole between January 2015 and December 2017 were analyzed: a metamizole-based cohort (Cohort 1) and a symptoms-based cohort (Cohort 2). Anonymized patient data was obtained from Amil Clinical Data Warehouse. The number of patients with symptoms was described by age and sex. Results The sample size of the two cohorts consisted of 384,668 patients. In patients using metamizole (Cohort 1), the most common reason for medication was the treatment of some form of pain (81%), followed by fever (19%). Headache was the most common (19%) specified pain class, followed by sore throat (8%), muscular pain (6%), and abdominal pain (5%). In adult patients (n=276,279; 71.8%), metamizole was used as a monotherapy or associated with another drug, for any sort of pain, in over 88% of the patients. General pain was the main reason for metamizole use in children (61%). Conclusion Real world evidence to evaluate Brazilian patients' therapeutic options is unusual and yet to be more explored using digital tools enabling better data registration. The present study confirmed that metamizole is widely used as a non-anti-inflammatory drug, and also showed the management of pain and fever as the most frequent indications in all age groups studied. Registry in Clinical Trials Database: REBEC Database: 10507

Use of different matrices to construct the standard curve for the paracetamol dosage by visible spectrophotometry / Uso de diferentes matrizes na construção da curva padrão para a dosagem de paracetamol por espectrofotometria visível

ABSTRACT Introduction: Acute paracetamol poisoning is confirmed by the determination of its serum level and allows assessing the risk of hepatotoxicity, which can be monitored by the Rumack-Matthew nomogram for the administration of the N-Acetylcysteine antidote, as well as for the prognosis of intoxication. Objective: Because of its analytical importance, we evaluated the influence of different matrices (ultrapure water, serum, and plasma) on the construction of the paracetamol calibration curve, aiming to reduce the analytical cost and facilitate its implementation in clinical and emergency laboratories. Material and methods: A standard stock solution of paracetamol of 1 mg ml-1 was obtained, from which appropriate dilutions originated the following concentrations 20, 50, 100, 150, 200, 250, and 300 mg l-1 in the different matrices, in triplicate, reading at complete after 430 nm in spectrophotometer and reproduced after three months. The results were statistically analyzed (p < 0.05). Results and discussion: Good laboratory practices include remaking the calibration curve when stock reagents are remade aiming to readjust the line equation indicated by a measuring instrument. The biological samples indicated as matrices on a calibration curve are usually serum and plasma. However, these biological products, when commercially purchased, are of high cost. Ultrapure water can replace serum and plasma in the paracetamol calibration curve according to the linearity of the curve, which showed the same trend line for the three matrices. Conclusion: The three matrices can be used in the construction of the paracetamol calibration curve, but the use of ultrapure water reduces the analysis costs.

RESUMEN Introducción: La intoxicación aguda por paracetamol se confirma mediante la determinación de su nivel sérico y permite evaluar el riesgo de hepatotoxicidad, que puede ser monitorizado mediante el nomograma de Rumack-Matthew para la administración del antídoto N-acetilcisteína, así como para el pronóstico de intoxicación. Objetivos: Por su importancia analítica, se evaluó la influencia de diferentes matrices (agua ultrapura, suero y plasma) en la construcción de la curva de calibración del paracetamol, con el objetivo de reducir el costo analítico y facilitar su implementación en laboratorios clínicos y de emergencia. Material y métodos: Se obtuvo una solución madre del estándar (stock) de paracetamol de 1 mg ml-1, de la cual se originaron diluciones adecuadas para obtener las siguientes concentraciones de 20, 50, 100, 150, 200, 250 y 300 mg l-1 con las diferentes matrices, por triplicado, con lectura a 430 nm en epectrofotômetro, reproduciéndose a los tres meses. Los resultados se analizaron estadísticamente (p < 0,05). Resultados y discusión: Las buenas prácticas de laboratorio incluyen rehacer la curva de calibración cuando se rehacen los reactivos del estándar con el fin de reajustar la ecuación lineal indicada por un instrumento de medición. Las muestras biológicas indicadas como matrices en una curva de calibración suelen ser suero y plasma. Sin embargo, estos productos biológicos cuando se compran comercialmente son de alto costo. El agua ultrapura puede reemplazar el suero y el plasma en la curva de calibración de paracetamol de acuerdo con la linealidad de la curva, que mostró la misma línea de tendencia para las tres matrices. Conclusión: Las tres matrices pueden usarse en la construcción de la curva de calibración de paracetamol, pero el uso de agua ultrapura reduce los costos de análisis.

RESUMO Introdução: A intoxicação aguda pelo paracetamol é confirmada pela determinação de seu nível sérico e permite avaliar o risco de hepatotoxicidade, que pode ser monitorado pelo nomograma Rumack-Matthew para a administração do antídoto N-acetilcisteína, bem como para o prognóstico da intoxicação. Objetivos: Diante de sua importância analítica, avaliamos a influência de diferentes matrizes (água ultrapura, soro e plasma) na construção da curva de calibração do paracetamol, visando diminuir o custo analítico e facilitar a sua implantação em laboratórios clínicos e de urgência. Material e métodos: Obtivemos uma solução estoque padrão de paracetamol de 1 mg ml-1, da qual originaram diluições apropriadas para se obter as concentrações de 20, 50, 100, 150, 200, 250 e 300 mg l-1 com as diferentes matrizes, em triplicata, com leituras em espectrofotômetro a 430 nm, sendo reproduzidas após três meses. Os resultados foram analisados estatisticamente (p < 0,05). Resultados e discussão: Nas boas práticas de laboratório, inclui-se o refazimento da curva de calibração quando os reagentes estoques são refeitos visando ao reajuste da equação de reta indicado por um instrumento de medição. As amostras biológicas indicadas como matrizes em uma curva de calibração são, usualmente, soro e plasma. Porém, esses produtos biológicos quando adquiridos comercialmente são de custo elevado. A água ultrapura pode substituir soro e plasma na curva de calibração do paracetamol em função da linearidade da curva, a qual mostrou a mesma linha de tendência para as três matrizes. Conclusão: As três matrizes podem ser utilizadas na construção da curva de calibração do paracetamol, mas o uso de água ultrapura diminui os custos da análise.

A study on parental perspectives towards childhood fever

Background: Parents play an important role in recognizing and treating paediatric fever as well as initiating home treatment. Their knowledge and attitude can greatly influence paediatric fever treatment and parental phobia may at times lead to overtreatment of fever. Objectives of this study was to assess the knowledge, attitudes and practices of parents towards childhood fever. Methods: This cross-sectional observational study was conducted in the Paediatric department at Saveetha Medical College, Chennai. Data collection from parents was done using a questionnaire to study the knowledge, attitude and practices of parents towards fever and its management in children. Data analysis was done using SPSS 16 software.Results: Total 100 parents participated in the study, most of participants were mothers (69%) and 51% were between 20-30 years. 67% parents believed that fever could cause harmful effects like convulsions and delirium whereas 61% parents believed that consumption of large doses of antipyretic is harmful. Majority of parents 87% were aware that vaccinations can cause fever. Around 82% of parents declared that they had sleepless nights whenever their child was febrile. Majority of the parents 95% stated that they confirmed the presence of fever in their child by tactile assessment. About half the parents preferred using injections for reducing fever than oral medications.Conclusions: The study revealed presence of high levels of anxiety in majority of parents highlighting the need for reassurance and counsel ling by health professionals. Since most of the parents relied on tactile assessment for fever, there is a need to educate them about proper use of a thermometer for accurate detection and better assessment of fever.

Conocimientos, creencias y manejo de la fiebre entre los padres consultantes en un Hospital Pediátrico de Tercer nivel en Pasto, Colombia, 2017

Introducción: En Colombia existen muchos mitos, y se observa diferentes abordajes de la fiebre. Sin embargo, no hay datos locales que muestren esta situación. El Objetivo de este estudio es Identificar los conocimientos, creencias, y manejos de la fiebre entre los padres consultantes. Materiales y Métodos: Estudio descriptivo, observacional, transversal, se aplicó un cuestionario a una muestra tomada conveniencia de 200 padres que consultaron al servicio de urgencia del hospital. Resultados: Se realizaron 200 encuestas. El 59% de los padres se encontraban en secundaria. El 84,5% de la población pertenecía a los estratos 1 y 2 y vivía en zona urbana. El 52% utilizaban termómetros o tiras plásticas para medir la temperatura. El 81,5% administró antibiótico solo cuando el médico lo prescribe. Las variables sociodemográficas de los padres, que tuvieron una relación estadísticamente significativa se relacionaron en el conocimiento, manejo y creencias de la fiebre fueron: edad de los padres, nivel educativo, estrato socieconomico y número de hijos. Conclusiones: Se encontraron falencias en el conocimiento de los padres en conceptos de fiebre y toma de temperatura. Los padres se basan en consultas previas al médico para la administración de medicamentos. En el manejo de la fiebre, la mayoría de padres utilizan medios físicos para disminuirla concomitante con el uso de antipiréticos; con respecto a las creencias, en nuestra región (Pasto - Nariño) siguen siendo utilizadas las terapias tradicionales para el manejo de fiebre.

Introduction: In Colombia there are many myths, and different approaches to fever are observed. However, there is no local data describing this situation. The objective of this study is to identify the knowledge, beliefs, and management of fever among parents requesting consultation. Materials and Methods: This was a descriptive, observational and cross-sectional study. A questionnaire was applied to a convenience sample of 200 parents who consulted at the emergency department of the hospital. Results: 200 surveys were carried out. 59% of parents were in high school. 84.5% of the population belonged to stratas 1 and 2 and lived in an urban area. 52% used thermometers or plastic strips to measure the temperature. 81.5% administered antibiotics only when the doctor prescribed it. The sociodemographic variables of the parents, which were significantly statistically e related to the knowledge, management and beliefs of the fever were: age of the parents, educational level, socioeconomic status and number of children. Conclusions: We found knowledge gaps in parents regarding fever and temperature measurement. Parents administer medications after consulting with a physician. In managing fever, most parents used physical means to reduce fever along with antipyretics. Regarding beliefs, in our region (Pasto - Nariño) traditional therapies for the management of fever are still used.

Study on antipyretic property of the leaves of Ligustrum robustum

Background: Thorough pharmacological experiments on various plants used in traditional medicines are in progress in order to establish their effectiveness and safety. But modern drugs or conventional medicines are often viewed as impersonal, emphasizing crisis intervention. Keeping in view the above idea, the present study is undertaken on the plant Ligustrum robustum to explore its antipyretic property in albino rats.Methods: Healthy young albino rats weighing between 100-250gm were obtained for the study. The animals were divided into five groups with six animals in each group. Pyrexia was induced by subcutaneous injection of dried yeast in 2% gum acacia in normal saline at a dose of 20ml/kg body weight below the nape of the neck in albino rats. The antipyretic activity of the aqueous extract of Ligustrum robustum was tested by yeast induced method. The data were subjected to ANOVA followed by Dunnett’s ‘t’ test for statistical significance between different groups.Results: Ligustrum robustum in doses of 100mg/kg, 200mg/kg and 400mg/kg significantly reduced the temperature (p<0.05 to 0.01) in the 3rd and 4th hour after drug administration.Conclusions: Present study concludes that the aqueous extract of the leaves of Ligustrum robustum showed significant antipyretic property in the standard experimental animal models.

Fiebre y terapia antipirética en el paciente con sepsis en la unidad de cuidados intensivos: actualización / Fever and antipyretic therapy in the septic patient in the intensive care unit: an update

Resumen La fiebre es un signo frecuente en el niño críticamente enfermo durante su estadía en la unidad de cuidados intensivos, y debe ser entendida como una respuesta biológica evolutiva, de carácter adaptativo normal del huésped al estrés fisiológico. Es el resultado de una compleja respuesta a estímulos pirogénicos, resultando en la generación de citocinas y prostaglandinas. Los mecanismos moleculares implicados en el inicio de la fiebre aún no están totalmente precisados, originando dificultades en el conocimiento de los procesos fisiopatológicos exactos involucrados y, por ende, necesarios para elaborar una adecuada y específica estrategia terapéutica. Estudios experimentales concluyen que la fiebre y la inflamación son benéficas para el huésped; no obstante, la terapia antipirética es comúnmente empleada y estudios en humanos sobre la presencia de fiebre y su tratamiento para el pronóstico del paciente crítico con sepsis no son concluyentes. Para el médico intensivista es esencial disponer de información actualizada referente a la fisiología de la termorregulación humana, el efecto de la temperatura en rango febril sobre múltiples procesos biológicos involucrados en la defensa del huésped y las intervenciones termorreguladoras en el paciente con sepsis.

Abstract Fever is a very common sign to observe in critically ill children during their intensive care unit stay. This should be understood as an evolutionary biological response, of normal adaptive character, from the host to the physiological stress. It is the result of a complex response to pyrogenic stimuli, resulting in the generation of cytokines and prostaglandins. The molecular mechanisms involved in the onset of fever are not yet fully specified, thus creating difficulties in the knowledge of the exact pathophysiological processes involved and, therefore, necessary to elaborate an adequate and specific therapeutic strategy. Experimental studies conclude that fever and inflammation are beneficial to the host. However, antipyretic therapy is commonly employed and human studies on the presence of fever and its treatment for the prognosis of critically ill septic patients are inconclusive. Up-to-date information on the physiology of human thermoregulation, the effect of temperature on febrile range over multiple biological processes involved in host defense, and thermoregulatory interventions in the septic patient are essential to know by the critical care physician.

Self-medication practices among rural households atChiraigaon Block, Varanasi

Background & Objective: Self-medication is defined as medication taken on the patient own initiative or on the advice of pharmacist or any other lay person. Unavailability of qualified medical personnel in rural areas pushes the rural households for self-medication practices. The present study was conducted to elicit the self-medication pattern among rural households and its indicators across various socio-demographic parameters. Method: A cross-sectional study was conducted among 270 household. The study was carried during November 2013 to January 2014. A predesigned and pretested questionnaire was used for the study. The door to door approached was used. Out of 1500 household, 270 were sampled in this study. Statistical Analysis: Data analysis was done by using Microsoft excel 2007.Result: Medicine was available in 46.7%. Among these medicine Antibiotics was most commonly available (84.1%), followed by Antipyretics (74.6%), Analgesic (64.3%), anti-histaminic (58.7%), Multivitamin (24.6%).Fever was the most common indication (83.3%) for self-medication, followed by Body ache/Headache (51.6%). Diarrhea (53.2%), Cough (61.9%) Weakness (23.8%). In 11.1% household medicine was found expired. 77.8% of household check expiry before use medicines. Unavailability of qualified doctor (36.5%) was most common reason for self-medication. Responded were getting these medicine from medical shops either by telling symptoms (38.1%) or by using empty blister/bottle (30.2%).Conclusion: Self-medication is increasing at alarming pace. There is need to ensure community education, safety and efficacy of self-medication.

An analysis of caregivers' preference regarding fever management in the emergency department

PURPOSE: To investigate caregivers' preference regarding fever management in the emergency department. METHODS: Between July 2011 and June 2014, we surveyed the preference in fever management by caregivers of febrile children aged 7 years or younger who visited the emergency department. The questionnaire consisted of the characteristics of the children and their caregivers, usefulness of tepid massage, and the caregivers' preference in fever management, in particular the combination of methods and the doses of antipyretics. RESULTS: Among a total of 161 children, 161 were enrolled in the study, with the mean age of 5.0 years. Of the caregivers, 64.6% were in their 30s and 50.9% were parents, and 70.2% and 24.2% reported that tepid massage was "very useful" and "a little useful," respectively. The most preferred combination of methods was "tepid massage, acetaminophen, and ibuprofen (50.9%; P < 0.001)." "Tepid massage and ibuprofen" was preferred to "tepid massage and acetaminophen (24.2% vs 7.5%)." The most preferred dose of antipyretics was 1 mL/kg/day (divided into 3 doses; 60.2%; P = 0.012), followed by 1 mL/kg/day (divided into 3 doses) plus 2 mL/dose (29.1%). CONCLUSION: Caregivers may recognize tepid massage as a useful fever management. The most preferred fever management was the combination of tepid massage, acetaminophen, and ibuprofen with a dose of 1 mL/kg/day.

Effects of extreme dose of heat-clearing drugs on the temperature of the patients with postoperative fever / 国际中医中药杂志

Objective To observe the effect of exteme dose of heat-clearing drugs on temperature in the postoperative fever patients.Methods A total of 70 patients with postoperative fever who met the inclusion criteria were randomly divided into the control group (35 patients) and observation group (35 patients). The observation group was treated with exteme dose of heat-clearing drugs, and the control group was treated with the common dose formula. Both groups were treated for 3 day, and followed up for 3 day. The changing of the temperature before and after treatment, the onset time and time of relieving fever were analyzed.Results Compared with the baseline before the treatment, the 1st day, 2nd after treatment, the highest temperature in observation group at thte 3rd day(37.5 ± 0.5℃vs. 37.6 ± 0.5℃, 38.1 ± 0.5℃,38.3 ± 0.5℃,F=20.883) was significantly lower; the highest body temperature in the control group at the 3rd day (37.5 ± 0.6℃vs. 37.5 ± 0.5℃, 38.1 ± 0.6℃, 38.4 ± 0.4℃,F=25.088) was significantly lower (P<0.01). At the 3 day in the follow up period, compared with the baseline before the treatment, the 1st day, 2nd after treatment, the highest body temperature in observation group (36.9 ± 0.5℃vs. 37.1 ± 0.2℃, 37.3 ± 0.5℃,F=7.778) were significantly lower (P<0.01).Conclusions The high of heat-clearing drugs treatment for the postoperative fever can effectively lower the temperature, and there is no obvious difference of the onset time and the time of relieving fever between two groups.

Effects of extreme dose of heat-clearing drugs on the temperature of the patients with postoperative fever / 国际中医中药杂志

Objective To observe the effect of exteme dose of heat-clearing drugs on temperature in the postoperative fever patients.Methods A total of 70 patients with postoperative fever who met the inclusion criteria were randomly divided into the control group (35 patients) and observation group (35 patients). The observation group was treated with exteme dose of heat-clearing drugs, and the control group was treated with the common dose formula. Both groups were treated for 3 day, and followed up for 3 day. The changing of the temperature before and after treatment, the onset time and time of relieving fever were analyzed.Results Compared with the baseline before the treatment, the 1st day, 2nd after treatment, the highest temperature in observation group at thte 3rd day(37.5 ± 0.5℃vs. 37.6 ± 0.5℃, 38.1 ± 0.5℃,38.3 ± 0.5℃,F=20.883) was significantly lower; the highest body temperature in the control group at the 3rd day (37.5 ± 0.6℃vs. 37.5 ± 0.5℃, 38.1 ± 0.6℃, 38.4 ± 0.4℃,F=25.088) was significantly lower (P<0.01). At the 3 day in the follow up period, compared with the baseline before the treatment, the 1st day, 2nd after treatment, the highest body temperature in observation group (36.9 ± 0.5℃vs. 37.1 ± 0.2℃, 37.3 ± 0.5℃,F=7.778) were significantly lower (P<0.01).Conclusions The high of heat-clearing drugs treatment for the postoperative fever can effectively lower the temperature, and there is no obvious difference of the onset time and the time of relieving fever between two groups.

Analysis of analgesic, antipyretic, and nonsteroidal anti-inflammatory drug use in pediatric prescriptions / Análise do uso de analgésicos, antipiréticos e anti-inflamatórios não esteroides em prescrição pediátrica

ABSTRACT OBJECTIVE: Data on clinical practice in pediatrics on the use of analgesic, antipyretic, and nonsteroidal anti-inflammatory drugs considering the best available evidence and regulatory-agency approved use are uncertain. This study aimed to determine the frequency of prescription of these drugs according to the best scientific evidence and use approved by regulatory agencies. METHODS: This was a cross-sectional study of 150 pediatric prescriptions containing analgesic, antipyretic, and nonsteroidal anti-inflammatory drugs, followed by interview with caregivers at 18 locations (nine private drugstores and nine Basic Health Units of the Brazilian Unified Health System). The assessed outcomes included recommended use or use with no contraindication, indications with benefit evidence, and health surveillance agency-approved use. Data were analyzed in electronic databases and the variables were summarized by simple frequency. RESULTS: A total of 164 analgesic, antipyretic, and nonsteroidal anti-inflammatory drugs were prescribed to 150 children aged 1-4 years (38.6%). Dipyrone was included in 82 (54.6%) and ibuprofen in 40 (26.6%) prescriptions. Non-recommended uses were identified in 15% of prescriptions and contraindicated uses were observed in 13.3%. Nimesulide (1.5%) is still prescribed to children younger than 12 years. The dose was incorrect in 74.3% of prescriptions containing dipyrone. Of the 211 reported clinical indications, 56 (26.5%) had no evidence of benefit according to the best available scientific evidence and 66 (31.3%) had indications not approved by the regulatory agencies. CONCLUSION: There are significant discrepancies between clinical practice and recommended use of analgesic, antipyretic, and nonsteroidal anti-inflammatory drugs in pediatrics.

RESUMO OBJETIVO: Dados sobre a prática clínica em pediatria no uso de analgésicos, antipiréticos e anti-inflamatórios não esteroides considerando a melhor evidência disponível e o uso aprovado por agências reguladoras são incertos. Este estudo tem como objetivo verificar a frequência de prescrição de tais medicamentos segundo a melhor evidência científica e o uso aprovado por agências reguladoras. MÉTODO: Estudo transversal de 150 prescrições pediátricas, contendo analgésicos, antipiréticos e anti-inflamatórios não esteroides, seguido de entrevista aos cuidadores, em 18 locais (nove drogarias privadas e nove unidades de saúde do SUS). Os desfechos avaliados incluíram uso recomendado ou sem contraindicação, indicações com evidência de benefício e o uso autorizado por agências de vigilância sanitária. Os dados foram analisados em banco eletrônico e as variáveis sumarizadas por frequência simples. RESULTADOS: Foram prescritos 164 analgésicos, antipiréticos e anti-inflamatórios não esteroides para as 150 crianças entre um e quatro anos (38,6%). Dipirona constou em 82 (54,6%) e ibuprofeno em 40 (26,6%). Usos não recomendados foram encontrados em 15% das receitas e usos contraindicados em 13,3%. Nimesulida (1,5%) ainda é usada em crianças com menos de 12 anos. Em 74,3% das prescrições contendo dipirona a dose estava incorreta. Das 211 indicações clínicas referidas, 56 (26,5%) não tinham evidências de benefício segundo a melhor prova científica disponível e 66 (31,3%) eram indicações não aprovadas em agências de vigilância sanitária. CONCLUSÃO: Existem importantes discrepâncias entre prática clínica e recomendações de uso de analgésicos, antipiréticos e anti-inflamatórios não esteroides em pediatria.

Childhood Fever Management: Current Practice vs Evidence

PURPOSE: The purposes of this review were to address misconceptions of childhood fever and fever management practice among parents and health care providers, and to identify the scientific evidences against such misconceptions and practices. METHODS: Journal databases and clinical guidelines from 2000 to 2015 were searched. The search terms were fever, fever management, misconception, myth, fiction, fact, fever phobia, child, antipyretics, tepid bath, alternating use/combined use of antipyretics, and physical cooling method. RESULTS: There are significant gaps between current concepts and practices, and the scientific evidence. Misconceptions and unrealistic concerns about childhood fever still exist among parents and even health care providers, worldwide. The evidences suggest that antipyretics should be given carefully with the aim of relieving discomfort or pain rather than decreasing the temperature itself. Alternating use of antipyretics should be discouraged due to the risk of confusion and error. Antipyretics do not prevent febrile convulsions. Moreover, the scientific evidence does not support tepid sponge massage. CONCLUSION: Evidence-based childhood fever management interventions should be targeted toward parents and health care providers. By adopting an evidence-based approach to nursing interventions, pediatric nurses can ensure children receive appropriate and safe fever management.

Effects of the Enamel Erosion Caused by Certain Antipyretic and Analgesic Medicines for Children / 치위생과학회지

This study was conducted to provide basic understanding regarding possible enamel erosion by three kinds of fist-aid antipyretic and analgesic medicines over a period of time, with comparison and analysis of the resulting deciduous teeth surface and microhardness changes. The analysis was performed using energy dispersive X-ray spectroscopy (EDX) and scanning electron microscope (SEM) to examine the surface erosion and changes. The Kruskal-Wallis test show differences in surface erosion and changes after 3, 5 and 8 days of treatment as well as before and after the treatment in each group. According to the results, there was no significant difference in the early deciduous teeth enamel surface microhardness (p>0.01). However there were signigicant changes after 3, 5, and 8 days (p0.05). In the surface observation with the SEM treatment with Children's Tylenol® tablet, which has the lowest pH, looked the roughest, followed by Brufen syrup for children and Children's Tylenol® suspension. Based on these results, it should be considered that antipyretic and analgesic medicines for children, which have lower pH values, may cause tooth erosion. Hence, it is necessary to give special attention to oral hygiene in young children or infants by brushing their teeth after such drugs are administered.

Antipyretic Efficacy of Intravenous Propacetamol in the Management of Fever for Children Less than 15 Years of Age in an Emergency Center

PURPOSE: Fever is one of the most common symptoms in children visiting the emergency department. When oral antipyretics use is limited, IV antipyretics may be necessary for control of fever. In this study, we examined the current status of use and antipyretic effect of propacetamol, a precursor of acetaminophen, in fever management for children of age younger than 15 in an emergency center. METHODS: We reviewed medical records of 101 patients who were prescribed IV propacetamol from September 1st to December 31st in 2013. Among these patients, 59 children received propacetamol via intravenous injection for control of fever. We investigated variable data including age, sex, weight, chief complaint, reason for use of intravenous propacetamol, history of liver disease, and body temperature before the injection. In addition, to examine the antipyretic efficacy of IV propacetamol, we thoroughly investigated administration dose, number of injections, use of other antipyretics, other antipyretic therapy (ex. like tepid massage or ice bag), fever clearance time, etc. RESULTS: Intravenous propacetamol at a dose of 26.16 mg/kg was used in 59 patients and fever was controlled under 38degrees C within 2 hours in 39 patients (66.1%). Fever was relieved under 38degrees C within 4 hours or general condition was improved in 49 patients (83.0%). CONCLUSION: In this study, we examined the antipyretic efficacy of intravenous propacetamol in management of fever for children younger than 15 years of age in an emergency center. Optimized uses of intravenous propacetamol according to age and weight were effective for pediatric patients with fever who cannot swallow oral medications.

Devemos tratar febre em doentes graves? Resumo da evidência atual de três ensaios clínicos randomizados / Should we treat fever in critically ill patients? A summary of the current evidence from three randomized controlled trials

A febre é uma resposta não específica a vários tipos de insultos, de origem infecciosa ou não, e sua importância em doenças continua a ser um enigma. Nosso objetivo foi resumir a evidência atual para o uso de antipiréticos em pacientes graves. Foram realizadas revisão sistemática e meta-análise de publicações entre 1966 e 2013. As bases de dados MEDLINE e CENTRAL foram pesquisadas para estudos sobre antipirese em pacientes graves. A meta-análise restringiu-se a ensaios clínicos randomizados em humanos adultos; pacientes graves; tratamento com antipiréticos em um braço contra placebo ou não tratamento no outro; e dados sobre mortalidade. Os desfechos avaliados foram: mortalidade geral na unidade de terapia intensiva, mudança de temperatura e tempo de internação na unidade de terapia intensiva e no hospital. Três ensaios clínicos randomizados com 320 participantes foram incluídos. Os pacientes tratados com antipiréticos tiveram mortalidade na unidade de terapia intensiva semelhante aos controles (razão de risco de 0,91, com intervalo de confiança de 95% de 0,65-1,28). A única diferença observada foi uma diminuição na temperatura após 24 horas em pacientes tratados com antipiréticos (-1,70±0,40 x - 0,56±0,25ºC; p=0,014). Não houve diferença entre tratar ou não a febre em pacientes graves.

Fever is a nonspecific response to various types of infectious or non-infectious insult and its significance in disease remains an enigma. Our aim was to summarize the current evidence for the use of antipyretic therapy in critically ill patients. We performed systematic review and meta-analysis of publications from 1966 to 2013. The MEDLINE and CENTRAL databases were searched for studies on antipyresis in critically ill patients. The meta-analysis was limited to: randomized controlled trials; adult human critically ill patients; treatment with antipyretics in one arm versus placebo or non-treatment in another arm; and report of mortality data. The outcomes assessed were overall intensive care unit mortality, changes in temperature, intensive care unit length of stay, and hospital length of stay. Three randomized controlled trials, covering 320 participants, were included. Patients treated with antipyretic agents showed similar intensive care unit mortality (risk ratio 0.91, with 95% confidence interval 0.65-1.28) when compared with controls. The only difference observed was a greater decrease in temperature after 24 hours in patients treated with antipyretics (-1.70±0.40 versus - 0.56±0.25ºC; p=0.014). There is no difference in treating or not the fever in critically ill patients.

Study on Analgesic and Antipyretics Effect of Re-Du-Ning Injection / 世界科学技术-中医药现代化

This article was aimed to study the analgesic and antipyretic effect of Re-Du-Ning (RDN) Injection. Heating model was building on SD rats after subcutaneous injection of yeast. And then, RDN Injection was intravenous injected at the dose of 10.16 g·kg-1, 5.08 g·kg-1, and 2.54 g·kg-1, respectively. Observation was made on changes of rats' temperature. RDN Injection was intravenous injected into ICR mice at the dose of 20.30 g·kg-1, 10.15 g·kg-1, 5.08 g·kg-1 for 7 consecutive days. The methods of mice twist, hot plate and jaw pain were used in the testing of analgesic action of RDN Injection. The results showed that RDN Injection at high and middle dose can significantly reduce the temperature of heating rats models (P < 0.05 or P < 0.01). It can also significantly reduce the twisting times of mice by acetic acid (P< 0.05 or P< 0.01). It can also significantly increase the pain threshold of mice by hot plate and jaw pain (P< 0.05 or P< 0.01). It was concluded that RDN Injection had a good analgesic and antipyretic effect in mice.

Effect of patchouli oil on lipopolysaccharide-induced fever in rabbits / 中国病理生理杂志

[ ABSTRACT] AIM:To investigate the antipyretic effect of patchouli oil on lipopolysaccharide ( LPS)-induced fe-ver in rabbits.METHODS:Male rabbits (n=42) were randomly divided into 7 groups according to their body weight and basal body temperature, including control group, model group, western medical positive group, traditional Chinese medical positive group, and high, middle and low doses (2%, 1%and 0.5%) of patchouli oil groups.Subsequently, except the controls, the rabbits were injected with LPS at a dose of 1 mL/kg (2 mg/L) through marginal ear vein to establish rabbit fever model and the rabbits in control group received the same volume of NS.The rabbits in control group and model group were injected with 0.5%Tween-80 0.5 h late, and the rabbits in the other groups were treated with correspoonding drugs. The effect of patchouli oil on the body temperature was observed, and the levels of interleukin-1β( IL-1β) and tumor nec-rosis factor-α(TNF-α) in the serum, and prostaglandin E2(PGE2) and cyclic adenosine monophosphate (cAMP) in the hypothalamus were measured by radioimmunoassay.RESULTS: The body temperature and the levels of IL-1β, TNF-α, cAMP and PGE2 in model group were significant higher than those in control group.Patchouli oil notably inhibited the body temperature in the febrile rabbits.From 1.5 h to 5.5 h after administration, the body temperatures were increased by (1.06 ±1.55), (1.62 ±1.36), (1.38 ±1.22), (0.98 ±0.98) and (0.48 ±0.95) ℃in high patchouli oil group, re-spectively.From 3.5 to 5.5 h after administration, the body temperatures were elevated by ( 1.47 ±0.73 ) , ( 1.15 ± 0.68) and (0.63 ±0.54) ℃ in middle patchouli oil group, respectively.A tendency of downregulation of the elevated body temperatures was observed at every time point after administration in low patchouli oil group.Patchouli oil significantly decreased the levels of TNF-αin the serum and cAMP content in the hypothalamus, and attenuated the elevated tendency of the IL-1βlevel in the serum and PGE2 level in the hypothalamus.CONCLUSION:Patchouli oil evidently has antipyretic effect on LPS-induced fever in the rabbits.The antipyretic mechanism might be related to the inhibition of TNF-αlevel in serum and cAMP content in the hypothalamus.

Analgésicos, antipiréticos e anti-inflamatórios não esteroides em prescrições pediátricas / Analgesics, antipyretics and non-steroidal anti-inflammatory drugs in pediatric prescriptions

O uso de analgésicos, antipiréticos e anti-inflamatórios não esteroides por crianças muitas vezes não tem aprovação das agências reguladoras, nem respaldo das evidências científicas. Prescrições pediátricas podem ser influenciadas por fatores que não favorecem o uso racional dos medicamentos desta classe. O objetivo deste trabalho foi avaliar a utilização de analgésicos, antipiréticos e anti-inflamatórios não esteroides em crianças, considerando os setores público (SUS) e privado (N-SUS). A amostra foi composta por 150 prescrições (101 SUS e 49 N-SUS) seguidas de entrevista aos cuidadores, em dezoito locais (nove drogarias privadas e nove Unidades de Saúde do SUS). Os medicamentos foram prescritos de forma apropriada, segundo faixa etária, somente em 21,8% (SUS) e 29,6% (N-SUS) das prescrições. Mais de 95% das receitas, independente da origem, não atenderam aos critérios estabelecidos para avaliação do uso racional, com erros de dose, frequência e duração do tratamento. A análise das prescrições de analgésicos, antipiréticos e anti-inflamatórios não esteroides para crianças não apresentou diferenças significantes nos setores público e privado.

The use of analgesic, antipyretic and non-steroidal anti-inflammatory drugs by children more often than not neither have the approval of regulatory agencies nor the endorsement of scientific evidence. Pediatric prescriptions can be influenced by factors that do not promote the rational use of drugs by this category. The objective of this study was to evaluate the use of analgesic, antipyretic and non-steroidal anti-inflammatory drugs in children, considering the public (SUS) and private (N-SUS) sectors. The sample comprised 150 prescriptions (101 SUS and 49 Non-SUS) followed by interviews with the caregivers in eighteen locations (nine private drugstores and nine units of the Unified Health System (SUS). The drugs were prescribed appropriately, by age group, only in 21.8% (SUS) and 29.6% (Non-SUS) prescriptions. Over 95% of prescription, regardless of source, did not meet the established criteria for evaluation of their rational use, with dosage, frequency and duration of treatment errors. The analysis of prescriptions for analgesic, antipyretic and non-steroidal anti-inflammatory drugs for children revealed no significant differences between the public and private sectors.

Condutas terapêuticas e uso alternado de antipiréticos no manejo da febre em crianças / Therapeutic procedures and use of alternating antipyretic drugs for fever management in children

OBJETIVO: As evidências sobre a eficácia do uso alternado de antitérmicos no manejo da febre são escassas e apontam diferenças clinicamente desprezíveis. O objetivo do estudo foi descrever condutas terapêuticas e uso alternado de antipiréticos em crianças, e avaliar fatores associados ao uso alternado. MÉTODOS: Estudo transversal com 692 crianças de zero a seis anos, residentes no Sul do Brasil. Por meio de amostragem por conglomerados, foram realizadas entrevistas domiciliares com os cuidadores, utilizando questionário estruturado. Foi realizada análise descritiva e avaliada a associação entre o uso alternado de antipiréticos e fatores sociodemográficos. Foram analisados 630 casos (91,0%), correspondendo às crianças com histórico de febre. RESULTADOS: Cerca de 73% dos cuidadores informaram que a primeira medida adotada no último episódio de febre foi administrar medicamentos. A média de temperatura considerada febre foi de 37,4 ºC, e febre alta, 38,7 ºC. A utilização de terapia alternada com antipiréticos foi relatada por 26,7% dos entrevistados, justificada pela ausência de resposta à monoterapia e indicação médica, na maioria dos casos. Os medicamentos mais utilizados foram dipirona e paracetamol. Crianças cujo principal cuidador era um dos pais, com melhores condições socioeconômicas e maior nível educacional, receberam mais medicamentos alternados. Cerca de 70% das doses utilizadas estavam abaixo da dose mínima recomendada para tratamento de febre. CONCLUSÕES: O uso de medicamentos para controlar a febre é uma prática comum, incluindo esquemas alternados de antipiréticos. A maioria dos cuidadores considera como febre temperaturas inferiores às preconizadas, e apontou não resposta à monoterapia e indicação médica como as principais razões para o uso alternado.

OBJECTIVE: The evidence on the effectiveness of alternating antipyretics in fever management is scarce and indicates clinically negligible differences. The present study aimed to describe therapeutic procedures and the use of alternating antipyretics in children, and to evaluate associated factors. METHODS: This was a cross-sectional study with 692 children aged 0 to 6 years, living in Southern Brazil. Household interviews of the children's caregivers were conducted through cluster sampling using a structured questionnaire. A descriptive analysis was carried out, and the association between the use of alternating antipyretics and sociodemographic factors was evaluated. A total of 630 cases were analyzed (91.0%), corresponding to children with a history of fever. RESULTS: Approximately 73% of caregivers reported that the first measure adopted during the last fever episode was the administration of medication. The mean temperature considered as fever by caregivers was 37.4 ºC, and as high fever, 38.7 ºC. The use of alternating antipyretic therapy was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical indication, in most cases. The drugs most often used were dipyrone and paracetamol. Children whose primary caregiver was a parent with higher socioeconomic status and higher educational level received more alternating medications. Approximately 70% of the doses used were below the minimum recommended dose for the treatment of fever. CONCLUSIONS: The use of medication to control fever is a common practice, including alternating antipyretic regimens. Most caregivers consider as fever temperatures lower than those established and they reported lack of response to monotherapy and medical indication as the main reasons for alternating medication.