Choosing the optimal antipyretic drug in pediatric practice

How to lower an adult's fever: 8 best drugs

September 14, 2022
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Content

• How to choose fever pills
• Why does the temperature rise
• What to do at elevated temperatures
• How to reduce fever without medication
• The best antipyretics
• Paracetamol
• Nimesil
• Nurofen Long
• Theraflu ExtraTab
• Ibuklin
• Maxicold
• Rinza
• Aspirin

An increase in temperature is a signal from the body that there is an inflammatory process somewhere. An increase in temperature is a protective response of the immune system, the purpose of which is to eliminate the problem. But there are situations when the temperature urgently needs to be brought down. We will tell you which antipyretic pills are best to choose.

How to choose fever pills

Antipyretic drugs come in two categories:

• antipyretics
  (such drugs have a good antipyretic effect, they relieve pain a little, but do not in any way affect the source of inflammation). These are mainly paracetamol-based drugs;
• NSAIDs
  (these drugs relieve inflammation, reduce pain and reduce fever). In this category, the most famous drug is aspirin, but it has a lot of side effects. Today, instead of aspirin, there are many other, safer drugs for fever. One of them is ibuprofen.

Why does the temperature rise

The temperature can rise for various reasons. All of them can be divided into the following groups:

1. Infectious diseases caused by viruses (ARVI, influenza, intestinal infections, coronavirus, etc.).
2. Infections caused by bacteria (tonsillitis, bronchitis, pharyngitis, pneumonia, skin inflammation and intestinal infections).
3. Complications after operations, post-traumatic complications due to infection and tissue inflammation.
4. Autoimmune diseases.
5. Oncological processes (including blood diseases).

Also, body temperature may increase after overheating, against the background of endocrine diseases, due to problems with metabolism or taking certain medications. Non-pathological causes of fever also include: stress, premenstrual syndrome, menstruation, pregnancy, teething in babies.

By the way, a slightly elevated temperature can sometimes be a variant of the norm - as an individual feature of the body.

When to start lowering the temperature

During a slight increase in body temperature, there is no need to use medications to reduce thermoregulation. This is even harmful, as it can lead to pathologies and a chronic course of the disease. There is no point in loading weak organs with unnecessary medical supplies.

An increase in body temperature to 38.5° indicates the need to reduce it. This can be done with the help of various medications and unconventional methods that are guaranteed to eliminate the fever. The best option is to call the doctor home and get prescriptions regarding the treatment of the main disease and reducing the high temperature.

If the thermometer readings reach 41°-42°, then independent treatment is strictly prohibited. When the turning point of 42° is reached, irreversible consequences begin to occur in the human body, which can cause a negative effect on the organs and systems of the body. In particular, this factor greatly affects the human brain. It is urgent to call an ambulance and undergo the necessary examination.

What to do at elevated temperatures

If you have a slight fever, do not rush to immediately swallow an antipyretic. If the numbers are 38-38.5, just try to have a good rest, drink a lot of warm liquids and get some sleep. Give the body the opportunity to cope with the infection on its own.

If you feel normal at an elevated temperature (up to 38.5 degrees), you are at home, you can try to lower the temperature without pills: wipe your body with a damp towel moistened with water at room temperature.

But if you do not tolerate an increase in temperature, it has risen above 38.5 degrees, be sure to take an antipyretic. Especially if you have a headache, general weakness or convulsions (in this case you need to call an ambulance).

Take any medications (including antipyretics) with caution if you are prone to allergies. Often tablets or syrups for fever contain flavorings and dyes.

Often the dose of fever medication is calculated based on body weight. If a child’s temperature has risen, it can only be brought down with certain medications, so be sure to check the instructions for contraindications.

Tablets for fever, as we wrote above, are divided into two groups: NSAIDs and antipyretics. Drugs based on NSAIDs in combination with antispasmodics are good at reducing fever, which does not decrease for a long time (usually emergency doctors give such injections). But before using drugs with NSAIDs, it is necessary to assess the general health of the patient - NSAIDs are contraindicated for gastrointestinal diseases.

At elevated temperatures, it is imperative to look for the cause and fight it. This is usually a viral or bacterial infection. If it is bacterial, antibiotics are prescribed, but if it is a virus, then there is no special treatment, only symptomatic. Antiviral drugs are ineffective here. It is important to immediately consult a doctor if antipyretic drugs do not reduce the temperature well or the condition only worsens.

When should you give antipyretics to your child?

The use of antipyretics is necessary in the following cases of increased body temperature:

• age up to 3 months.
• if there is a tendency to develop seizures (or a history of seizures with an increase in temperature in the child)
• in the presence of diseases of the nervous and cardiovascular systems
• with a sharp increase in fever
• at temperatures above 38.5C
• with poor tolerance to fever
• when vomiting/diarrhea occurs
• with white fever

White fever

This is an unfavorable variant of the course of fever. In this case, a spasm of the skin vessels occurs, a marble pattern appears, the skin turns pale to a bluish tint, the hands and feet become very cold.

All the heat that the body produces remains in the organs and tissues. Heat transfer is disrupted, but production remains at the same level. Chills appear, increasing the fever. Using antipyretics alone may not help in such situations. The appearance of symptoms of white fever is a reason to seek emergency medical help.

How to reduce fever without medication

There are non-drug methods of reducing fever that can be used either alone or while taking antipyretics.

1. If you are feeling chilly, you should not wrap yourself up too much, so as not to disrupt heat transfer - this will only aggravate the condition. You need to cover yourself until you are comfortable, but not too hot.
2. Don't forget to have enough liquid. The body tries to cool down - the body sweats and loses fluid. If there is little water in the body, the condition will worsen. The liquid also helps remove waste products of pathogenic microorganisms from the body.
3. If you don't have an appetite, don't force yourself (or your child) to eat. During illness, all the body's strength is spent fighting infection.
4. To reduce your temperature without medication, wipe your body with a towel moistened with water at room temperature.
5. At elevated temperatures, ice can be applied to large vessels. First you need to crush the ice and put it in a bag. An ice pack should be applied through a towel - to the groin folds, armpits, forehead, popliteal fossa.
6. Raspberry, cherry, currant, and strawberry jam are considered folk remedies for fever (you can add tea or simply stir with warm water).

If the above methods of reducing fever do not work, be sure to take an antipyretic.

Paracetamol

You can buy Paracetamol in tablets, capsules, syrup, suspension and in the form of rectal suppositories. The active substance is paracetamol. The antipyretic is available without a prescription. This is the safest remedy, effective and prescribed for ARVI. Compared to other drugs, Paracetamol is weaker because it does not have an anti-inflammatory effect - for bacterial infections it is better to choose other tablets for fever. Paracetamol moderately reduces headaches and reduces general malaise. The temperature begins to drop 30-40 minutes after taking the drug, the effect lasts for 4-6 hours. Paracetamol is safe for both children and the elderly, pregnant and lactating women. The only exception is people with severe liver disease and chronic alcoholism. Paracetamol should not be taken with alcohol, for prophylaxis or as a course - only at high temperatures.

Paracetamol MS

Medisorb, Russia

Paracetamol is used for: relieving moderate or mild pain (headache, toothache, migraine, sore throat, neuralgia, myalgia);
reducing elevated body temperature during colds and other infectious and inflammatory diseases. Paracetamol is intended for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease. from 2

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Antiviral drugs for high fever for adults and children

Preparations with tilorone

Preparations in which the main active ingredient is tilorone stimulate the formation of all types of interferons, enhance the formation of antibodies and restore the normal relationship between cells of the immune system. They are both an interferon inducer and suppress the proliferation of viruses inside the cell, which subsequently leads to relief of the symptoms of the disease and a decrease in body temperature. Most often, such drugs are taken according to a certain schedule, once every 1-2 days. The maximum concentration of the active component in the blood is achieved on the first day after taking the tablet.

Special instructions: You can only take antiviral drugs with tilorone from 7 years of age.

Preparations with azoximer bromide

Drugs of this type activate the absorption of pathogens by cells of the immune system (phagocytosis). They also stimulate the production of antibodies and two types of interferons - alpha and gamma. Available in the form of tablets, suppositories and solution for injection. The tablets contain milk sugar and are contraindicated for lactose intolerance.

Special instructions: Also among the contraindications are children under three years of age.

Preparations based on imidazolylethanamide pentanedioic acid

These drugs belong to the group of immunomodulators. They slow down the creation of new viral particles in affected cells, make cell receptors more susceptible to interferon and normalize the content of this biological compound. The therapeutic effect is achieved only if you start taking it no later than the second day of illness.

Special instructions: Antiviral drugs of this type can be taken for the treatment of ARVI and influenza from the age of 7 years.

Medicines containing umifenovir

Umifenovir acts on respiratory viruses, it suppresses the process of incorporation of the virus into the body's cells. The drug is also used to prevent ARVI. Available in the form of tablets, suspensions and capsules.

Special instructions: Can be used after the first trimester of pregnancy in consultation with your doctor. The suspension can be given to children from two years of age, tablets - depending on the volume of the active substance from three, six and twelve years.

Preparations containing purified antibodies

Medicines containing purified antibodies to interferon gamma, histamine and CD4 cell receptors are classified as immunomodulatory and anti-inflammatory drugs. They promote the activation of immune cells responsible for protecting the body from viruses, provide anti-inflammatory activity in the mucous membranes of the respiratory tract and help eliminate itching and irritation of the nasal mucosa, which causes constant sneezing. Under the influence of drugs with antibodies, the permeability of the capillaries of the nasal mucosa is significantly reduced, which leads to a reduction in the amount of nasal discharge. Available in tablet form.

Special instructions: Drugs in this group can be given to children from 6 months.

Preparations containing meglumine acridone acetate

The drugs have a direct antiviral effect, suppressing viral reproduction in the early stages of the infectious process, reducing the infectivity of viral offspring and leading to the formation of defective viral particles. Increases the body's nonspecific resistance to viral and bacterial infections. Available in tablet form.

Special instructions: Drugs in this group can be given to children from 4 years of age.

Preparations containing interferon alpha-2b and highly active antioxidants (vitamins C and E)

For colds, flu and fever, you can also take the antiviral drug VIFERON. It is available in the form of suppositories and gel ointments. Human recombinant interferon alpha-2b, which is part of VIFERON, can fight viruses, has immunomodulatory properties and suppresses the replication of RNA and DNA viruses. Antiviral therapy against ARVI and influenza can be started at any phase of the disease. This may help improve the condition and prevent complications from developing. The drug VIFERON includes antioxidants generally recognized by medicine: in suppositories these are vitamins C and E, in ointments - vitamin E, in gel - vitamin E, citric and benzoic acids. Against the background of such antioxidant support, an increase in the antiviral activity of interferons is noted.

Preparations containing interferon have high non-selective activity. This means that such drugs are able to fight all types of acute respiratory viral infections, in some cases without additional tests or specifying the strain of the influenza virus.

Special instructions: The drug VIFERON Suppositories is approved for children from 1 day of life, as well as premature babies from the age of 34 weeks. During pregnancy, the drug can be used from the 14th week of gestation1; there are no contraindications for use during breastfeeding

Viferon gel is approved for children from 1 day of life, Viferon Ointment - from 1 year. External forms of the drug VIFERON (gel and ointment) have no contraindications for use during pregnancy.

The use of VIFERON Suppositories as part of complex antiviral therapy makes it possible to reduce therapeutic doses of antibacterial and hormonal drugs, as well as reduce the toxic effects of this therapy.

The medicine can be used in combination with antipyretic drugs.

Reference and information material

Author of the article

Belyaev Dmitry Alexandrovich

General doctor

1. VIFERON Suppositories are approved for use by children from the first days of life and pregnant women from the 14th week of pregnancy, VIFERON Gel - by children from the first days of life, there are no restrictions for use during pregnancy, VIFERON Ointment - from 1 year, there are no restrictions for use during pregnancy.

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Nimesil

The active ingredient of the antipyretic drug is nimesulide. These are NSAIDs with pronounced anti-inflammatory, antipyretic and analgesic effects. You can buy Nimesil at the pharmacy in individual sachets. Among the contraindications to taking Nimesil are diseases of the gastrointestinal tract (the full list is listed in the instructions, so be sure to read it before taking the drug). "Nimesil" should be used only after consultation with a doctor.

Nimesil

Berlin-Chemie/Menarini, Germany

Treatment of acute pain (back pain, lower back pain; pain syndrome in the musculoskeletal system, including injuries, sprains and dislocations of joints, tendonitis, bursitis; toothache);
— symptomatic treatment of osteoarthritis with pain syndrome; - algodismenorrhea. The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use. from 24

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Comparison table of characteristics

In order to compare the presented products, we suggest taking a look at the table below with their characteristics.

Nurofen Long

"Nurofen Long" for fever is sold in tablets, capsules, syrup. You can also buy a combination drug "Nurofen" with paracetamol. Nurofen does not require a prescription, and its active substance is ibuprofen (NSAID). Nurofen Long perfectly reduces the temperature literally 20 minutes after taking the tablet, and the effect lasts for 8 hours. The drug also reduces muscle pain, relieves headaches and inflammation, relieves nasal congestion, and relieves pain. Nurofen Long is recommended for bacterial infections and exacerbation of chronic diseases. The drug helps with elevated temperature due to ARVI. Contraindications include intolerance to ibuprofen and fructose, gastrointestinal diseases (including gastritis and ulcers), liver and kidney diseases. You should not drink alcohol while taking Nurofen. Nurofen is prescribed during pregnancy only if there is an urgent need.

Nurofen Long

Reckitt Benckiser, Netherlands

Backache;
joint pain; muscle and rheumatic pain; neuralgia; headache; migraine; toothache; painful menstruation; a sore throat; feverish condition; cold and flu symptoms. The drug is especially indicated for the symptomatic treatment of pain requiring a more pronounced analgesic effect than ibuprofen or paracetamol alone. from 137

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Criteria for choosing a suitable product

Before purchasing medications, you need to study the recommendations for their purchase.

• Compound. Carefully study the components of the antipyretic drug. If there is at least one ingredient that you personally cannot tolerate, move on to choosing another product.
• Brand. Buy products that you are already familiar with or have heard about before. The more popular the drug, the more effective and safe it will be.
• Taste or smell. This factor is also important, especially when choosing medications for children.
• Comfort during dosing and use. Some drugs, especially suspensions, are sold complete with special spoons or marked syringes. This factor ensures the correct dosage and the elimination of errors in application.

Theraflu ExtraTab

These fever tablets contain paracetamol, which reduces fever well. In addition, Theraflu ExtraTab contains phenylephrine (a vasoconstrictor) and chlorphenamine (an antihistamine). Therefore, the drug has a complex effect - it relieves swelling during a runny nose and reduces fever. Contraindications to taking Theraflu ExtraTab include stomach ulcers.

Theraflu extratab

Novartis Pharma Services AG (Novartis Pharma), Switzerland

Symptomatic treatment of infectious and inflammatory diseases (ARVI, including influenza), accompanied by high fever, chills, headache, runny nose, nasal congestion, sneezing, muscle pain.
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Ibuklin

This is a complex antipyretic drug - here paracetamol and ibuprofen (antipyretic and NSAID). You can buy Ibuklin without a prescription; the product reduces fever well, relieves cold symptoms, reduces inflammation and body aches, and improves overall well-being. “Ibuklin” begins to act 20 minutes after administration, and the effect lasts 6-8 hours. Contraindications: liver and kidney diseases, gastrointestinal problems (ulcers, gastritis). Ibuklin should not be taken with alcohol.

Ibuklin

Dr. Reddy's Laboratories, India

- symptomatic treatment of infectious and inflammatory diseases (colds, flu), accompanied by fever, chills, headache, muscle and joint pain, sore throat;
- myalgia; - neuralgia; - back pain; — joint pain, pain syndrome in inflammatory and degenerative diseases of the musculoskeletal system; - pain from bruises, sprains, dislocations, fractures; — post-traumatic and postoperative pain syndrome; - toothache; - algodismenorrhea. The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use, and does not affect the progression of the disease. from 78

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Maxicold

The drug "Maxicold" contains paracetamol. This antipyretic drug perfectly relieves all symptoms of ARVI. In addition to Maxicold, you can buy Maxicold Rhino at the pharmacy, which will effectively relieve a runny nose and swelling of the nasal mucosa thanks to phenylephrine and pheniramine (vasoconstrictor and antiallergic effects). Maxicold contains vitamin C, a natural antioxidant that strengthens the immune system and helps the body fight colds.

Maxicold

JSC Pharmstandard-UfaVITA, Russia

- symptomatic treatment of infectious and inflammatory diseases (including influenza and other acute respiratory viral infections (ARVI)), accompanied by fever, chills, nasal congestion, headache, pain in the bones and muscles, in the throat and sinuses.
from 39

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Maxicold Rhino

OJSC Pharmstandard-Leksredstva, Russia

- symptomatic treatment of colds, acute respiratory viral infections, flu, accompanied by high fever, chills, headache, runny nose, pain in the sinuses and throat, nasal congestion, sneezing and pain in muscles and joints.
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Choosing the optimal antipyretic drug in pediatric practice

Fever is one of the main reasons for seeking medical care in pediatrics, accounting for up to 30% of all doctor visits by children in general and up to 2/3 of visits by children under three years of age [1, 2].

Depending on the etiological factor, it is customary to distinguish two main groups of fever: infectious and non-infectious (with aseptic immune inflammation, tissue damage and dysfunction of the autonomic and central nervous system (CNS)) [3].

In Russia, fever in children is most often associated with infectious diseases, especially acute respiratory viral infections (ARVI). Most children with ARVI are treated at home; parents often resort to self-medication using over-the-counter analgesics [4].

Meanwhile, moderate fever is an important protective and adaptive reaction of the body, promoting the death of pathogens of infectious diseases, the production of antibodies, and the activation of phagocytosis and immunity. The use of antipyretics is sometimes undesirable due to the fact that they can mask the clinical manifestations of severe infections, delay the establishment of the correct diagnosis, which increases the risk of complications and deaths [5]. When a child receives antibacterial therapy, regular use of antipyretic medications may mask the insufficient effectiveness of the antibiotic [3].

On the other hand, an increase in body temperature to very high values ​​(> 40 °C) can contribute to the development of cerebral edema and dysfunction of vital organs [6]. A rise in temperature above 38 °C is dangerous for children in the first two months of life due to imperfect thermoregulation processes, for children aged 6 months to 3 years who are at risk for the development of febrile seizures, as well as in the presence of severe respiratory and cardiovascular diseases. vascular systems, the course of which can worsen with fever [7].

In children with central nervous system pathology (perinatal encephalopathy, epilepsy, etc.), seizures may develop against the background of elevated body temperature [8]. Febrile seizures occur in 2–4% of children, most often at the age of 12–18 months [6].

The purpose of prescribing antipyretic drugs to children is not only to prevent the above complications and dehydration, but also to reduce the discomfort associated with fever [9, 10]. Moreover, some experts consider the elimination of discomfort to be the main goal of treating fever in pediatrics [11].

The question of using an antipyretic for fever in a child should be decided individually. Children at risk for developing complications from febrile reactions include:

• under 2 months of age with a temperature above 38 °C;
• with a history of febrile seizures;
• with diseases of the central nervous system;
• with chronic pathology of the circulatory system;
• with hereditary metabolic diseases [12].

Russian pediatricians recommend prescribing antipyretic drugs to children in the first 3 months of life at a temperature > 38 °C, and to children over 3 months (previously healthy) at a temperature > 39 °C and/or for muscle aches and headaches [13].

In addition, antipyretics are recommended for all children with a history of febrile seizures at temperatures > 38–38.5°C, and for severe heart and lung disease at temperatures > 38.5°C.

Antipyretic therapy should be carried out against the background of etiological treatment of the underlying disease, and in children with allergic diseases (atopic dermatitis, allergic rhinitis) against the background of the use of antihistamines [4].

When choosing an antipyretic drug, it is always necessary to weigh its benefit/risk ratio for a given pathology, assessed on the basis of the results of adequate randomized controlled trials. It is necessary to give preference to the most well-studied drugs in pediatrics, of which there are very few today - 75% of drugs on the pharmaceutical market have never been studied in adequate clinical studies in children [14, 15]. An important factor when choosing a drug for children is also the availability of pediatric dosage forms and their organoleptic properties (taste, smell), as well as ease of dosing and use, which allows increasing adherence to pharmacotherapy and preventing medical errors.

Among the drugs with analgesic and antipyretic effects, the most well studied in pediatrics are ibuprofen and paracetamol. These drugs are recommended by the World Health Organization; they are the only representatives of their group approved for over-the-counter use for fever and pain in children in most economically developed countries, including the Russian Federation. Paracetamol and ibuprofen can be prescribed to children from the first months of life both in a hospital and at home [3]. The use of other non-opioid analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) in pediatric patients is limited due to both the lack of data on effectiveness in this population and the risk of serious side effects. Some NSAIDs are only available by prescription for the treatment of arthritis in children and adolescents.

It should be noted that there are significant differences between paracetamol and ibuprofen that must be taken into account when choosing antipyretics (Table).
Ibuprofen, unlike paracetamol, has not only antipyretic and analgesic, but also anti-inflammatory properties, so its use is more preferable in children with fever accompanied by inflammatory processes, for example, sore throat, otitis media, arthritis, etc. [16]. Table. Regimens for the use of paracetamol and ibuprofen for the treatment of fever in children [8]

Evidence of the effectiveness of ibuprofen for fever in children

The effectiveness and safety of ibuprofen in children with fever has been studied in more than 120 clinical trials, most of which included paracetamol as a comparator [17].

The results of these studies indicate that, both in single doses and in repeated doses, ibuprofen is at least as effective as or superior to paracetamol.

For example, in an open-label, randomized, three-parallel group study of children aged 6–24 months, ibuprofen at a dose of 7.5 mg/kg was superior to paracetamol and acetylsalicylic acid (both at a dose of 10 mg/kg) [18]. ].

A more pronounced antipyretic effect of ibuprofen at doses of 7.5 and 10 mg/kg compared with paracetamol at a dose of 10 mg/kg has been demonstrated in a number of other clinical studies in children [19–23]. Additionally, in a double-blind, placebo-controlled, randomized clinical trial of 127 children 2–11 years of age, ibuprofen was shown to be better at reducing high fever (>39.2°C) than paracetamol [24].

The higher efficacy of ibuprofen as an antipyretic in children when used at a dose of 5–10 mg/kg compared with paracetamol at doses of 10–12.5 mg/kg was confirmed by the results of a meta-analysis that included 17 blinded randomized clinical trials [17]. The superiority of ibuprofen was observed at all time intervals studied (2, 4 and 6 hours after administration) and was most pronounced between 4 and 6 hours after the start of treatment, when the effect of ibuprofen was more than 30 points higher than the effect of the comparison drug. When studies in which ibuprofen was used at a dose of 5 mg/kg were excluded from the analysis, its advantage over paracetamol increased even more (the effect was approximately 2 times stronger than that of paracetamol). The incidence of side effects, including gastrointestinal and renal side effects, was similar.

The conclusion about the superiority of ibuprofen over paracetamol in terms of antipyretic and analgesic efficacy in adults and children was also made in the latest published meta-analysis, which included data from 85 comparative clinical studies of these drugs, including 35 studies comparing antipyretic activity [26].

Analysis of published data allows us to recommend ibuprofen as the drug of choice for the treatment of fever in children, since it causes a more pronounced decrease in body temperature than paracetamol, without increasing the risk of adverse events [27].

Very interesting data were obtained in a study by Autret-Leca et al. (2007): Although ibuprofen and paracetamol were found to be comparable in effectiveness and tolerability, significantly more parents in the ibuprofen group than in the paracetamol group rated the drug their children were receiving as “very effective” both open-label and in the blinded phase of the study [28]. The authors believe that this assessment may be explained by some additional benefit of the drug, which could not be measured in this study, but reduced parents' anxiety about their children's treatment.

Another study focused on parental satisfaction when their children (n = 490) received ibuprofen suppositories as an antipyretic at a dose of 5–10 mg/kg/dose [29]. The average rating of parents' satisfaction on a 5-point scale was 4.5 ± 0.47; 92.2% of parents said they would use this drug in the future.

There are fewer comparative studies of ibuprofen with other antipyretics, since the use of the latter (for example, acetylsalicylic acid and metamizole sodium) in children is limited due to safety concerns. However, available evidence suggests that ibuprofen is also superior in effectiveness. As mentioned above, ibuprofen at a dose of 7.5 mg/kg was superior in effectiveness to acetylsalicylic acid at a dose of 10 mg/kg [18].

In a comparative study of 80 children aged 6 months to 8 years, a single dose of ibuprofen 10 mg/kg had a greater antipyretic effect than a single dose of Dipirone (metamizole sodium) 15 mg/kg [30]. The benefit of ibuprofen was particularly pronounced in children with high (>39.1°C) body temperature. In other comparative clinical studies, ibuprofen was not inferior in effectiveness to metamizole sodium preparations for intramuscular administration, which allowed the authors to recommend giving preference in pediatrics to ibuprofen as an oral drug, the use of which is not associated with pain and other undesirable consequences of injections [31, 32].

The advantage of ibuprofen over other antipyretics is the rapid (within 15 minutes) development of the antipyretic effect [32, 33] and its long duration (8 hours) [25].

Ibuprofen has been shown to be effective for the treatment (at a dose of 7.5 mg/kg) and prevention (at a dose of 20 mg/kg/day, divided into 3 doses) of post-vaccination reactions, including fever [34]. The preventive effect of the drug against post-vaccination reactions was especially pronounced in children aged 3 months [34].

Although relief of the discomfort associated with fever is considered to be the main purpose of antipyretic administration, targeted research on this issue is virtually absent. As mentioned above, one randomized trial showed a more favorable effect of ibuprofen on this indicator compared to paracetamol and acetylsalicylic acid [18].

In a small domestic study involving 30 children aged 3 months to 2 years with fever due to ARVI, the use of Nurofen suppositories for children (60 mg) led to a more rapid improvement in well-being, normalization of sleep and appetite than the use of paracetamol suppositories (80 mg) [35 ].

This may be explained by both the wider spectrum of pharmacological action of ibuprofen and its more favorable effect on the temperature curve (speed of onset of effect, duration of action). It is possible that the reason may be the variable bioavailability of paracetamol when administered rectally [36].

Thus, evidence-based medicine data indicate that ibuprofen has advantages over paracetamol and other antipyretics in terms of effectiveness as an antipyretic in children with fever. Many experts believe that ibuprofen should be considered the drug of choice for fever in children and adults [10, 25–28, 37, 38].

The attitude of experts towards combination therapy with ibuprofen and paracetamol is contradictory. In the recent double-blind clinical trial PITCH, which compared the effectiveness of the combination of paracetamol (15 mg/kg) and ibuprofen (10 mg/kg) with monotherapy for fever in children aged 6 months to 6 years with a temperature of 37.8–41, 0 °C or more, the combination of drugs made it possible to normalize body temperature 23 minutes faster than paracetamol alone, but not faster than ibuprofen [38].

A systematic review that analyzed data from 7 randomized clinical trials failed to show any significant benefit or harm from combination therapy [25]. In this regard, the review authors consider the use of combination therapy inappropriate. Most other experts also recommend avoiding combination therapy due to safety concerns, including potential drug overdose [10, 11, 38–41]. In the case of combined or alternate use of paracetamol and ibuprofen, to prevent overdose, it is recommended to record the time of administration of each dose of the drugs [38]. Based on the results obtained, the authors recommended starting treatment of young children with ibuprofen monotherapy as the drug of choice.

Literature

1. Boivin JM, Weber F., Fay R., Monin P. Management of pediatric fever: is parents' skill appropriate? //Arch Pediatr. 2007; 14: 322–329.
2. Porth CM, Kunert MP Alteracoes na regulacao da temperatura. In: Porth CM, Kunert MP Fisiopathology. 6a ed. Rio de Janeiro: Guanabara Koogan; 2004. P. 190–201.
3. Korovina N.A., Zakharova I.N., Zaplatnikov A.L. Acute fever in children // RMZh. 2005, no. 17, 1165–1170.
4. Geppe N. A. The place of ibuprofen in antipyretic therapy for children with allergic conditions // Consilium medicum. 2003, no. 6.
5. Niven DJ, Leger C., Kubes P., Stelfox HT, Laupland KB Assessment of the safety and feasibility of administering anti-pyretic therapy in critically ill adults: study protocol of a randomized trial // BMC Res Notes. 2012, Mar 16; 5:147.
6. Cremer OL, Kalkman CJ Cerebral pathophysiology and clinical neurology of hyperthermia in humans // Prog Brain Res. 2007; 162:153–169.
7. Ketova G. G. Features of the use of antipyretic drugs in children // RMZh. 2008, no. 18, 1170–1172.
8. Timchenko V.N., Pavlova E.B. Modern approaches to the treatment of fever in children with infectious pathology // RMZh. 2008, No. 3, p. 113–117.
9. Lava SA, Simonetti GD, Ramelli GP et al. Symptomatic management of fever by Swiss board-certified pediatricians: results from a cross-sectional, Web-based survey // Clin Ther. 2012, Jan; 34(1):250–256.
10. Chiappini E., Principi N., Longhi R. et al. Management of fever in children: summary of the Italian Pediatric Society guidelines // Clin Ther. 2009, Aug; 31(8):1826–1843.
11. Sullivan JE, Farrar HC Fever and antipyretic use in children // Pediatrics. 2011, Mar; 127(3):580–587.
12. Zaplatnikov A.L. Rational use of antipyretic drugs for ARVI in children // RMZh. 2009, no. 19, 1223–1236.
13. Tatochenko V.K., Uchaikin V.F. Fever // Pediatric pharmacology. 2006; 3:43–44.
14. Carleton BC, Smith MA, Gelin MN, Heathcote SC Paediatric adverse drug reaction reporting: understanding and future directions // Can J Clin Pharmacol. 2007, Winter; 14(1):e 45–57.
15. Yewale VN, Dharmapalan D. Promoting appropriate use of drugs in children // Int J Pediatr. 2012; 2012: 906570. Epub 2012 May 8.
16. Timchenko V. N., Pavlova E. B. Experience of using the drug “Nurofen for children” in the treatment of infectious diseases in children. Information mail. St. Petersburg, 2006. 8 p.
17. Perrott DA, Piira T., Goodenough B., Champion GD Efficacy and safety of acetaminophen vs ibuprofen for treating children's pain or fever: a meta-analysis // Arch Pediatr Adolesc Med. 2004, Jun; 158(6):521–526.
18. Autret E., Reboul-Marty J., Henry-Launois B. et al. Evaluation of ibuprofen versus aspirin and paracetamol on efficacy and comfort in children with fever // Eur J Clin. 1997; 51: 367–371.
19. Wilson JT, Brown RD, Kearns GL et al. Single-dose, placebo-controlled comparative study of ibuprofen and acetaminophen antipyresis in children // J Pediatr. 1991 Nov; 119(5):803–811.
20. Autret E., Breart G., Jonville AP et al. Comparative efficacy and tolerance of ibuprofen syrup and acetaminophen syrup in children with pyrexia associated with infectious diseases and treated with antibiotics // Eur J Clin Pharmacol. 1994; 46(3):197–201.
21. Van Esch A, Van Steensel-Moll HA, Steyerberg EW et al. Antipyretic efficacy of ibuprofen and acetaminophen in children with febrile seizures // Arch Pediatr Adolesc Med. 1995, Jun; 149(6):632–637.
22. Czaykowski D., Fratarcangelo P., Rosefsky J. Evaluation of the antipyretic efficacy of single dose ibuprofen suspension compared to acetaminophen elixir in febrile children // Pediatr. Res, 1994, 35, Abstr. 829.
23. Goldman RD, Ko K., Linett LJ, Scolnik D. Antipyretic efficacy and safety of ibuprofen and acetaminophen in children // Ann Pharmacother. 2004; 38 (1): 146–150.
24. Walson PD, Galletta G., Braden NJ, Alexander L. Ibuprofen, acetaminophen, and placebo treatment of febrile children // Clin Pharmacol Ther. 1989, July; 46(1):9–17.
25. Pursell E. Treating fever in children: paracetamol or ibuprofen? // Br J Community Nurs. 2002; 7: 316–320.
26. Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review // Ann Pharmacother. 2010, Mar; 44(3):489–506.
27. Allan GM, Ivers N., Shevchuk Y. T reatment of pediatric fever: Are acetaminophen and ibuprofen equivalent? // Can Fam Physician. 2010, Aug; 56(8):773.
28. Autret-Leca E., Gibb IA, Goulder MA Ibuprofen versus paracetamol in pediatric fever: objective and subjective findings from a randomized, blinded study // Curr Med Res Opin. 2007, Sep; 23(9):2205–2211.
29. Hadas D., Youngster I., Cohen A. et al. Premarketing surveillance of ibuprofen suppositories in febrile children // Clin Pediatr (Phila). 2011, Mar; 50 (3): 196–199.
30. Magni AM, Scheffer DK, Bruniera P. Antipyretic effect of ibuprofen and dipyrone in febrile children // J Pediatr (Rio J). 2011, Jan-Feb; 87(1):36–42.
31. Prado J., Daza R., Chumbes O. et al. Antipyretic efficacy and tolerability of oral ibuprofen, oral dipyrone and intramuscular dipyrone in children: a randomized controlled trial // Sao Paulo Med J. 2006. May 4; 124(3):135–140.
32. Yilmaz HL, Alparslan N., Yildizdas D. Intramuscular Dipyrone versus Oral Ibuprofen or Nimesulide for Reduction of Fever in the Outpatient Setting // Clin Drug Investig. 2003; 23(8):519–526.
33. Pelen F. et al. Treatment of Fever: monotherapy with ibuprofen. Ibuprofen pediatric suspension containing 100 mg/5 ml, Multicentre acceptability study conducted in hospital // Ann. Pediatr. 1998; 45, 10: 719–728. Br J Community Nurs. 2002, Jun; 7 (6): 316–320.
34. Diez-Domingo J., Planelles MV, Baldo JM et al. Ibuprofen prophylaxis for adverse reactions to diphtheria-tetanus-pertussis vaccination: a randomized trial // Curr Ther Res. 1998; 59:579–588.
35. Klyuchnikov S. O., Barsukova M. V., Dubovich E. G., Suyundukova A. S. Rational approaches to the use of antipyretic drugs in children // RMJ. 2010, no. 5, p. 243–247.
36. Anderson B. Paracetamol. In: Jacqz-Aigrain E, Choonara I, editors. Pediatric Clinical Pharmacology. New York: Taylor & Francis; 2006, p. 621–627.
37. Mennick F. Ibuprofen or acetaminophen in children? As the debate continues, the evidence may favor ibuprofen // Am J Nurs. 2004, Sep; 104(9):20.
38. Hay AD, Costelloe C, Redmond NM et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomized controlled trial // BMJ. 2008, Sep 2; 337:a1302.
39. Meremikwu M., Oyo-Ita A. Paracetamol for treating fever in children. Cochrane Database Syst Rev. 2002; (2): CD003676.
40. Kearns GL, Leeder JS, Wasserman GS Combined antipyretic therapy: another potential source of chronic acetaminophen toxicity // J Pediatr. 1998; 133:713.
41. Purssell E. Combining paracetamol and ibuprofen for fever in children // BMJ. 2008; 337:593.

1 This drug is not registered in the Russian Federation.

E. A. Ushkalova, Doctor of Medical Sciences, Professor

FSBI NTsAGiP im. V. I. Kulakova Ministry of Health and Social Development of Russia, Moscow

Contact information about the author for correspondence

Rinza

Rinza tablets are a complex drug. The product contains caffeine, which enhances the antipyretic effect and improves metabolic processes. Paracetamol helps reduce fever and relieve muscle pain. Phenylephrine relieves swelling of the nasal mucosa, chlorphenamine is an antihistamine against inflammation. "Rinza" relieves cold symptoms for 12 hours. This drug is contraindicated for pregnant women, hypertensive patients, patients with atherosclerosis, those treated with antidepressants, people with kidney and liver diseases; alcohol should not be taken while being treated with Rinza.

Rinza

Unique Pharmaceutical Laboratories, India

- symptomatic treatment of “colds”, acute respiratory viral infections (including influenza), accompanied by fever, pain, and rhinorrhea.
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How to bring down a fever without antipyretics

There are other ways that help reduce fever without medication. Let's look at them below.

1. Remove excess clothing.
2. Wipe yourself with water. Place a wet compress on your forehead and armpits.
3. Move less. Excessive physical activity reduces strength and also causes overheating.
4. Drink more fluids. Unless, of course, you are pregnant or suffer from edema.
5. Take a warm shower. The water temperature should be 36-37 degrees. Colder water may cause chills.

Aspirin

Aspirin can be bought both in regular tablets and in effervescent form. This is an NSAID whose active substance is acetylsalicylic acid. Aspirin has a strong antipyretic effect, it is an excellent pain reliever, while the anti-inflammatory effect of the drug is very weak. After taking Aspirin, relief occurs within 15 minutes (faster if these are effervescent tablets). But you need to remember that Aspirin is not the safest drug for fever. Allergies often occur to it; asthmatics, allergy sufferers and those who have problems with the gastrointestinal tract and liver should not drink it. It is prohibited for children under 15 years of age and pregnant women to take Aspirin with alcohol.

Aspirin

Children's antipyretic: aspirin, analgin, ibuprofen, paracetamol

When choosing an antipyretic drug for a child, it is necessary, first of all, to take into account the safety of the drug, and also pay attention to the ease of use and the availability of children's dosage forms for different age groups.

Despite the high effectiveness of analgesics and antipyretics, their use in children is not always safe. Thus, there is convincing evidence that the use of acetylsalicylic acid (Aspirin) for viral infections in children may be accompanied by Reye's syndrome, characterized by toxic encephalopathy and fatty degeneration of internal organs, mainly the liver and brain. Acetylsalicylic acid increases the risk of developing inflammatory changes in the gastrointestinal tract, disrupts blood clotting, increases vascular fragility, and in newborns it can displace bilirubin from its connection with albumin and thereby contribute to the development of bilirubin encephalopathy. WHO experts do not recommend the use of acetylsalicylic acid as an antipyretic in children under 12 years of age. By order of the Pharmaceutical Committee of the Russian Federation, the use of acetylsalicylic acid for acute viral infections is permitted from the age of 15. However, under the supervision of a doctor, acetylsalicylic acid can be used in children with rheumatic diseases.

In pediatrics, antipyrine, aminophenazone, phenazone, butadione, amidopyrine, and phenacetin were excluded due to toxicity . Due to the high risk of hepatotoxicity, the use of nimesulide as an antipyretic drug is not advisable. It has been established that nimesulide (Nise and Nimulid) has a significantly higher incidence of serious side effects when compared with ibuprofen and paracetamol in average therapeutic doses. In European countries, nimesulide is not approved for use in children under 12 years of age. The use of nimesulide in Russia is possible on the recommendation of a doctor in children over two years of age, but the prescription is advisable only when long-term anti-inflammatory therapy is necessary, which usually occurs in rheumatology.

Metamizole sodium ( Analgin ), which can cause anaphylactic shock, agranulocytosis, as well as a prolonged collapsing state, is not recommended as a first-line antipyretic drug. Analgin and metamizole-containing drugs can be used (parenterally only) in urgent situations, such as hyperthermic syndrome, acute pain in the postoperative period, and others that are not amenable to other therapy.

Thus, when choosing antipyretic drugs for children, it is especially important to focus on highly effective drugs with the lowest risk of adverse reactions.