How do you bring down a high fever?

In most children, a low temperature does not cause serious discomfort. If the child, despite the fever, remains active, then the prescription of antipyretics will be premature - in this case, further monitoring of the development of the disease is necessary. According to WHO recommendations, the prescription of antipyretic drugs to bring down a high temperature is indicated when the rectal temperature rises above 39 ° C, when there are no risk factors and the high temperature is proceeding favorably - "pink fever".

Indications for the administration of antipyretics, according to WHO recommendations

Groups of children	Only temperature	Fever with chills and pain
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 seizures - with CNS pathology - with chronic heart and lung diseases - with hereditary metabolic diseases	>38.5 °C	<38.5 °C

At high temperature with impaired microcirculation, the administration of antipyretic drugs is combined with intensive rubbing of the skin.

To bring down a high temperature, it is recommended to drink plenty of fluids and use physical cooling methods: undress the child and rub him/herself with water at room temperature. Rubbing with cold water or vodka is not indicated, as this can lead to spasm of the peripheral vessels, which will reduce heat transfer. Deterioration of general well-being even against a favorable premorbid background is an indication for prescribing antipyretics at any temperature. Unfavorable course of high temperature with severe 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, history of febrile seizures, diseases of the central nervous system and hereditary metabolic diseases.

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

It is important to remember that it is unacceptable to use antipyretics for a course without searching for the cause of high temperature. Such tactics are dangerous due to diagnostic errors, in which the true cause of high temperature is missed, and serious bacterial diseases, such as pneumonia and pyelonephritis, remain unrecognized. The use of regular antipyretic therapy against the background of antibiotics also cannot be justified, since this complicates monitoring the effectiveness of etiotropic therapy. It is also necessary to remember about possible vegetative disorders that can cause fever in children in adolescence. In this case, a rise in temperature is typical during wakefulness, emotional stress and physical activity. Fevers of this type are not relieved by prescribing antipyretics, since their pathogenesis is not based on an increase in the synthesis of prostaglandins, which is the target for these drugs. Therefore, prescribing antipyretics in such cases is unfounded.

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

Currently, it is customary to distinguish two groups of analgesic-antipyretics:

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

The mechanism of action of all antipyretic drugs is to block the synthesis of prostaglandins in the hypothalamus. The anti-inflammatory effect of NSAIDs is associated with the peripheral action of these drugs at the site of inflammation and the suppression of prostaglandin synthesis locally. Paracetamol, unlike these drugs, acts only centrally, at the level of the hypothalamus.

Acetylsalicylic acid (aspirin) is known as an effective analgesic and antipyretic, but its use in children under 15 years of age to bring down a high temperature is contraindicated due to the risk of such a formidable complication as Reye's syndrome. The development of Reye's syndrome is associated with the use of acetylsalicylic acid in children against the background of acute respiratory viral infections. Reye's syndrome is characterized by uncontrollable vomiting with the appearance of toxic encephalopathy and fatty degeneration of internal organs, mainly the liver and brain. According to the FDA, the mortality rate is more than 50%. In recent years, due to the restriction of the use of acetylsalicylic acid, a decrease in the incidence of Reye's syndrome has been noted. However, acetylsalicylic acid continues to be widely used in children by both parents (up to 20%) and pediatricians (up to 60%). In addition to Reye's syndrome, acetylsalicylic acid is also characterized by 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 has been withdrawn from the pharmaceutical market in more than 30 countries and its use is strictly limited. This situation is due to the high relative risk of developing agranulocytosis with even short-term (less than 10 days) use of the drug. According to research, about 20% of parents use metamizole sodium as an antipyretic. The use of metamizole sodium should be limited to emergency 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, 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 for children are ibuprofen and paracetamol. Paracetamol is prescribed to children from 3 months to 15 years old at a dose of 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 paracetamol overdose, its hepatotoxic effect is described with "course" use. Hepatotoxicity occurs when the concentration of paracetamol in the blood is higher than 150 mcg/ml (after 4 hours), we are talking about doses that significantly exceed the daily dose of 60 mg/kg. Taking cytochrome P450 activators, such as rifampicin, phenobarbital, increases the toxicity of paracetamol. In case of paracetamol overdose, it is necessary to perform gastric lavage and immediately prescribe a specific antidote - N-acetylcysteine (initially 150 mg/kg intravenously in 200 ml of 5% glucose solution for 15 minutes, then 50 mg/kg in 1 l of 5% glucose solution for 16 hours). Contraindications to the use of paracetamol include age up to 1 month, severe liver and kidney dysfunction, glucose-6-phosphate dehydrogenase deficiency, and blood diseases.

One of the successfully used drugs that contains paracetamol is Cefekon D.

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

Available in three ready-to-use dosages for children from 1 month to 12 years old.

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

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

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

A small child can be given a suppository Cefekon D even in a dream. After all, very often the temperature rises in the middle of the night. when the baby has not fully woken up or. having woken up, is capricious and refuses to take syrup or a tablet. In this case, it is convenient to use rectal suppositories Cefekon D, without causing discomfort to the child.

For older children, Cefekon D is the drug of choice for hyperthermic syndrome associated with gastrointestinal tract diseases, especially the upper gastrointestinal tract. In this case, Cefekon D rectal suppositories are an opportunity to avoid the negative impact of the drug on the mucous membrane of the stomach and duodenum.

Cefekon D is a convenient remedy for fever and pain for children!

To reduce fever, ibuprofen is used in a dose of 5 to 20 mg / (kg x day). The effect occurs in 30-60 minutes, the peak activity is observed in 2-3 hours. The maximum concentration in the plasma is achieved 45 minutes after administration: the duration of action is up to 8 hours. Unlike paracetamol, ibuprofen has not only a central but also a peripheral effect, which is associated with its anti-inflammatory effect. Inhibition of prostaglandin synthesis at the site of injury leads to a decrease in inflammation activity, a decrease in phagocytic production of acute phase cytokines. The pronounced anti-inflammatory activity of ibuprofen causes an expansion of 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. The side effects of ibuprofen are common for the NSAID group of drugs and are associated with inhibition of the synthesis of protective prostaglandins E. Possible side effects may include nausea, anorexia, gastrointestinal disorders, liver dysfunction, allergic reactions, anemia and thrombocytopenia, dizziness, and sleep disturbances. Acute poisoning develops when using ibuprofen in a dose exceeding 100 mg/kg. Children who have taken ibuprofen in a dose of more than 100 mg/kg are shown gastric lavage and home observation for 4 hours. When taking more than 200 mg/kg, hospitalization is indicated.

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