How to knock down heat?

In most children, low temperature does not cause serious discomfort. If the child, despite the fever, remains active, the appointment of antipyretic drugs will be premature - in this case, further monitoring of the development of the disease is necessary. In accordance with the recommendations of the WHO, the appointment of antipyretic drugs to knock off the heat is indicated with an increase in the rectal temperature above 39 ° C, when there are no risk factors and the high temperature is favorable - "pink fever".

Indications for the administration of antipyretics, as recommended by WHO

Groups of children	Only temperature	Temperature with chills and pains
Healthy 0-2 months	> 38.0 ° C	<38.0 ° C
Healthy> 2 months	> 39.5 ° C	<39.5 ° C
Risk group: - the first 3 months of life - with a history of febrile convulsions - with pathology of the central nervous system - with chronic diseases of the heart and lungs - with hereditary metabolic diseases	> 38.5 ° C	<38.5 ° C

At a high temperature with a violation of microcirculation, the appointment of antipyretics is combined with intensive rubbing of the skin.

To bring down the heat, abundant drinking and physical methods of cooling are recommended: the baby is undressed and wiped off with water at room temperature. Wiping with cold water or vodka is not indicated, as this can lead to a spasm of the peripheral vessels, which will reduce heat emission. Deterioration of overall well-being even on a favorable premorbid background is an indication for prescribing antipyretics at any temperature. An unfavorable course of high temperature with pronounced intoxication, impaired peripheral circulation ("pale type") requires the use of antipyretic drugs at a temperature exceeding 38 ° C. Risk factors: severe pulmonary or cardiovascular disease (which can decompensate at high temperature), age up to 3 months, febrile convulsions in history, CNS diseases and hereditary metabolic diseases.

If the child is at risk, the temperature at which antipyretics is indicated also varies depending on the course of the fever. So, with a favorable "pink fever" it is necessary to reduce the temperature exceeding 38-38.5 ° C, and with "pale fever" shows a decrease in temperature above 37.5 ° C.

It is important to remember the inadmissibility of the course use of antipyretics without searching for the cause of high temperature. Such tactics are dangerous diagnostic errors. At which the true cause of high temperature is skipped, and serious bacterial diseases, such as pneumonia and pyelonephritis, remain unrecognized. The use of regular antipyretic therapy against antibiotics also can not be justified, since this makes it difficult to monitor the effectiveness of etiotropic therapy. It is necessary to remember and possible vegetative violations, which can cause fever in children during adolescence. This is characterized by a rise in temperature during the waking period, with emotional stress and physical activity. Fever of this type is not stopped by the appointment of antipyretics, because the basis of their pathogenesis is not an increase in the synthesis of prostaglandins, which is the target for these drugs. Therefore, the appointment of antipyretics in such cases is unreasonable.

An unfavorable course of high temperature requires a slightly different treatment tactic. It is necessary to combine the intake of antipyretic drugs with antihistamines and vasodilators. Single doses of antipyretics are standard. Moreover, hyperthermic fever, the presence of severe toxicosis require the appointment of an antipyretic in parenteral form, and the drug of choice in this situation will be analgin.

Currently, among the analgesics-antipyretics it is customary to distinguish two groups:

• NSAIDs: (acetylsalicylic acid, metamizole sodium, ibuprofen);
• paracetamol.

The mechanism of action of all antipyretics is to block the synthesis of prostaglandins in the hypothalamus. The anti-inflammatory effect of NSAIDs is related to the peripheral action of these drugs in the inflammatory focus and suppression of the synthesis of prostaglandins locally. Paracetamol, unlike these drugs, acts only centrally, at the hypothalamus level.

Acetylsalicylic acid (aspirin) is known as an effective analgesic and antipyretic, however its use in children under 15 years of age is contraindicated due to the danger of such a formidable complication as Ray's syndrome. The development of Reye's syndrome is associated with the use of acetylsalicylic acid in children on the background of ARVI. Rey's syndrome is characterized by indomitable vomiting with the appearance of toxic encephalopathy and fat degeneration of the internal organs, mainly the liver and brain. According to the FDA, the lethality is more than 50%. In recent years, in connection with the restriction of the use of acetylsalicylic acid, there has been a decrease in the incidence of Reye's syndrome. However, acetylsalicylic acid continues to be unreasonably widely used in children as parents (up to 20%) and pediatricians (up to 60%). In addition to Ray's syndrome, acetylsalicylic acid also has other side effects associated with the blockade of the synthesis of protective prostaglandins E. These include gastrointestinal bleeding, aspirin asthma and hypoglycemia. The use of acetylsalicylic acid in newborns can lead to bilirubin encephalopathy.

Metamizole sodium (analgin) also belongs to the NSAID group. Metamizole sodium in more than 30 countries withdrawn from the pharmaceutical market and its reception is strictly limited. This situation is caused by a high relative risk of agranulocytosis even with a short (less than 10 days) intake of the drug. According to research, about 20% of parents use methamizole sodium as an antipyretic. The use of sodium metamizole should be limited to urgent situations, such as malignant hyperthermia, treatment of severe acute pain in the postoperative period in children under 6 months, when the use of narcotic analgesics is contraindicated in acute renal or biliary colic, as well as in other acute clinical situations, when it is necessary to use the parenteral form of the drug.

The drugs of choice in children are ibuprofen and paracetamol. Paracetamol is prescribed for children from 3 months to 15 years is 10-15 mg / kg every 6 hours. Due to the central mechanism of action, paracetamol, unlike NSAIDs, does not irritate the gastric mucosa; it can be prescribed to children with bronchial obstruction. In most cases of overdoses of paracetamol, its hepatotoxic effect is described with "course" application. Hepatotoxicity is manifested when the concentration of paracetamol in the blood is above 150 μg / ml (after 4 hours), we are talking about doses far exceeding the daily dose of 60 mg / kg. The intake of cytochrome P450 activators, such as rifampicin, phenobarbital, increases the toxicity of paracetamol. In case of an overdose of paracetamol, gastric lavage should be performed and immediately a specific antidote, N-acetylcysteine, should be given (initially 150 mg / kg IV in 200 ml of 5% glucose solution for 15 min, then 50 mg / kg in 1 L of 5% glucose solution for 16 hours). Contraindications for the use of paracetamol include age up to 1 month, severe violations of the liver and kidneys, deficiency of glucose-6-phosphate dehydrogenase, blood diseases.

One of the successfully used drugs, which include paracetamol, is Cefekon D.

Cefekon D - antipyretic and analgesic drug for children in the form of rectal suppositories based on paracetamol.

It is available in three ready-to-use dosages for children from 1 month to 12 years.

When using Cefexon D, the action of the active substance lasts longer than paracetamol in the form of a syrup. This makes it convenient to use Cefekon D before bed.

Cefexon D does not contain dyes and preservatives, so it is suitable for children with a tendency to allergies.

Cefekon D can be used even if the fever in a child is accompanied by nausea or vomiting. Taking the drug does not provoke new attacks of nausea and vomiting, and the necessary dose of the active substance enters the body and lowers the temperature.

A small child can enter the suppository Cefekon D, even in a dream. Because very often the temperature rises in the middle of the night. When the baby did not wake up completely or. Waking up, capricious and refuses to take a syrup or a pill. In this case, it is convenient to use the rectal suppositories Cefekon D, without causing trouble to the child.

For older children, Cefekon D is the drug of choice for hyperthermic syndrome on the background of diseases of the gastrointestinal tract, especially its upper parts. Rectal suppositories Cefekon D in this case is an opportunity to avoid negative effects of the drug on the mucous membrane of the stomach and duodenum.

Cefekon D - a convenient remedy for heat and pain for children!

To bring down the temperature, ibuprofen is used in a dose of 5 to 20 mg / (kghsut). The action occurs in 30-60 minutes, peak activity is observed after 2-3 hours. The maximum concentration in the plasma is achieved 45 minutes after taking: the duration of action is up to 8 hours. Unlike paracetamol, ibuprofen exerts not only central but also peripheral action, with than its anti-inflammatory effect is connected. Inhibition of prostaglandin synthesis in the lesion site leads to a decrease in inflammatory activity, a decrease in the phagocytic production of acute inflammatory cytokines. The pronounced anti-inflammatory activity of ibuprofen causes an increase in indications for ibuprofen in comparison with paracetamol. In this regard, ibuprofen is used for infectious diseases, accompanied by inflammation, hyperthermia and pain. According to many studies, the anti-inflammatory effect of ibuprofen potentiates its antipyretic activity. Side effect of ibuprofen is common to the group of NSAID drugs and is associated with inhibition of the synthesis of protective prostaglandins E. Possible side effects may be nausea, anorexia, gastrointestinal disorders, liver function abnormalities, allergic reactions, anemia and thrombocytopenia, dizziness, sleep disturbance. Acute poisoning develops with the use of ibuprofen in a dose exceeding 100 mg / kg. Children who take ibuprofen at a dose of more than 100 mg / kg show gastric lavage and home observation for 4 hours. Admission of more than 200 mg / kg shows hospitalization.

[1], [2], [3], [4], [5], [6], [7]