Antipyretic medicines for children

Although feverishness signifies the body's fight against infection and contributes to a nonspecific immune response to infection, a fever of 38°C or higher in a child is the most common symptom encountered by pediatricians and emergency physicians. Antipyretics - antipyretics for children - are used to normalize body temperature.

Indications Antipyretics for children

Regardless of the cause of a subfebrile or febrile reaction antipyretics are used when fever in a child - to return temperature readings to normal.

Prescribing them, doctors understand that even a relatively moderate increase in body temperature in children, especially at the age of three months to five years, can lead to potentially serious consequences: dehydration of the body (with erythrocytosis - blood clotting), febrile convulsions, disruption of electrolyte metabolism and energy balance, intoxication of the body and excitation of the sympathetic nervous system.

Antipyretics should not be used arbitrarily, without a doctor's advice, for children in the first three to four months after birth.

Release form

Today, the most commonly used drugs for treatment of fever in children are the antipyretic analgesic Paracetamol (other trade names include Acetaminophen Panadol, Rapidol, Paralen, Infulgan, and such non-steroidal anti-inflammatory drugs (NSAIDs) as acetaminophen, Panadol, Rapidol, Paralen, Infulgan) and non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Ibuprex, Ibuprom, Ibufen Junior, Imet, Brufen, Nurofen).

Children aged 3-12 years are prescribed tablets Ibuklin junior (containing ibuprofen and paracetamol).

But Nimesulide (Nimesil, Nimulid, Naiz), which belongs to NSAIDs, is used to relieve acute pain (in children over 15 years of age), and its use for children under 12 years of age as an antipyretic has been officially canceled due to the increased risk of adverse effects on the liver.

It should be borne in mind that in cases of fever in acute respiratory viral infections, acute respiratory infections, etc. (caused by fever cytokines) not all fever pills are suitable for children. For example, acetylsalicylic acid (Aspirin) is not used because of the threat of a rare but dangerous side effect - Reye's syndrome, which is manifested by liver failure and encephalopathy.

The analgesic drug Analgin can also reduce fever, but it is not used in children under 12 years of age. In the USA, Canada, Great Britain, France, Sweden, Norway and Australia - due to possible side effects in the form of severe damage to hematopoiesis and myelotoxic action - this drug has long been banned. But in our pharmacies there are rectal suppositories Analgin for children, and the instructions for the drug in the form of a solution for injection indicate that children under 1 year of age are given intra-muscular injections, and for vital indications it is used only under the supervision of a doctor. In emergency cases (with high and hyperpyretic fever) can also be used lytic mixture of analgin and paracetamol.

In addition to regular and effervescent tablets, there are forms of antipyretics for children such as:

• Nurofen Forte oral suspension for children (from 6 months to 12 years), Ibufen Forte, Ibuprom, Darfen Kids Forte, Imet, Bofen (with ibuprofen), Paracetamol Baby (in 5 ml sachets), Piaron, Paralen Baby and Calpol (with paracetamol);
• antipyretic syrup for children - Paracetamol syrup for children (50, 100 and 120 ml bottles), Panadol Baby (with paracetamol);
• antipyretic suppositories for children (or rectal antipyretic suppositories) Efferalgan (Paracetamol), Cefecon and Paramax (also with paracetamol), etc.

Also read:

• Treatment of fever with medicines
• How do you bring down a high fever?
• Effective suppositories for fever

Homeopathic rectal suppositories Viburcol have antispasmodic, sedative and analgesic effect, but there is no indication of antipyretic effect in the official instructions. In addition, the constituents of this remedy Pulsatilla (meadowsweet of the buttercup family), Atropa belladonna (common belladonna or dye of the nightshade family) and Solanum dulcamara (sweet-bitter nightshade) are poisonous plants.

Viferon (other trade names are Laferomax, Alfarekin, Laferobion) is not an antipyretic drug; it contains human recombinant interferon alpha-2b (IFN-α 2b) and belongs to non-specific immunomodulators. Antiviral action, noted by the manufacturers of this means, allows you to use in its complex therapy of viral infections. The list of almost three dozen possible side effects of artificially produced IFN-α 2b (including hematopoiesis and psychiatric side effects) includes chills and fever.

To the echoes of outdated and pharmacologically unsound means include antipyretic with No-shpa for a child, because No-shpa (Drotaverine) is a myotropic antispasmodic, relieving painful spasms (colic) of the GI tract, biliary and urinary tract.

Pharmacodynamics

An increase in body temperature occurs when the concentration of physiologically active lipid compounds (fatty arachidonic acid derivatives) called prostaglandins E(2) - PGE(2) increases in certain areas of the brain. As inflammatory mediators, they increase the activity of neurons that control thermoregulation in the hypothalamus.

The mechanism of action of most antipyretics is to block COX, a cyclooxygenase enzyme synthesized in the CNS, and reduce PGE(2) levels in the hypothalamus.

Antipyretic effect of Paracetamol is due to blocking COX-3 - cyclooxygenase-3, which regulates pain reactions and fever; as a result, the biosynthesis of prostaglandins is reduced, which leads to a restructuring of the CNS thermoregulation center.

NSAIDs, such as the protopionic acid derivative Iibuprofen, work by inhibiting COX-2, which activates the conversion of arachidonic acid in brain phospholipids into prostaglandins. This causes a decrease in the synthesis of the prostaglandin PGE2.

Pharmacokinetics

After taking Paracetamol is rapidly absorbed in the small intestine, enters the blood (10% of the active substance binds to plasma proteins) and is transported to tissues. After a single dose, the maximum concentration in plasma is noted, on average, after 30 minutes with a gradual decrease over 6 hours. Paracetamol is 95% transformed in the liver, and excreted by the kidneys (with urine).

After intraintestinal absorption of orally taken Ibuprofen, more than 90% of the drug is bound to blood plasma proteins, and the peak concentration in serum is reached after 1-2 hours. Most of the drug is metabolized by hepatic isoenzymes and excreted, like Paracetamol, with urine.

How long do antipyretics for children last? After ingestion, Paracetamol reduces fever in about an hour and lasts for almost four hours, while Ibuprofen starts to work after half an hour and the antipyretic effect lasts for six to eight hours. Rectal suppositories for fever start working about 20 minutes later than oral remedies.

Dosing and administration

Tablets and capsules, suspensions and syrups are taken orally; antipyretic suppositories (suppositories) are administered rectally (in the lumen of the rectum).

Children 3-12 months are administered a suppository, the volume of which is 80 mg; children up to six years of age - 150 mg. It is allowed to use 3-4 suppositories per day with an interval between injections of at least six hours.

Syrups with Paracetamol the child takes orally, and the single dose depends on his age: from 6 to 12 months it is 60-120 mg; from one to three years -120-180 mg; from three to six years - 180-240 mg; over six years - 240-360 mg). The syrup is applied three times during the day. The interval between antipyretics for children - 4-6 hours, the duration of intake should not exceed three days.

For more information see. - Paracetamol for fever: dosage, how to take it

Antipyretic shots for children over one year of age (with a body weight of up to 10 kg) are an IV injection of 1% Paracetamol solution for injection; with this, a reduction in temperature is seen within half an hour and lasts for about six hours.

Accurate calculation of antipyretic for a child by weight should guarantee the maximum therapeutic effect with a minimum risk of side effects of drugs.

Thus, for Paracetamol, the maximum daily dose for a child whose body weight does not exceed 37 kg is 80 mg/kg; for 38-50 kg - 3 g per day; for ˃50 kg - 4 g per day. For Ibuprofen-based suspensions, the single dose for each kilogram of body weight is 7-10 mg (every 6-8 hours orally).

In case of fever associated with ARVI and insufficient effectiveness of one antipyretic, it is possible to alternate antipyretics for children under three years of age: first Paracetamol (single dose 12.5 mg/kg body weight), and six hours later Ibuprofen (single dose 5 mg/kg).

By the way, British pediatricians are strongly against such alternation.

Contraindications

Contraindications to the use of Ibuprofen are: blood coagulation disorders, functional failure of the kidneys or liver, exacerbation of inflammatory diseases of the GI tract, the presence of nonspecific ulcerative colitis, bronchial asthma in combination with multiple polyps of the nasal cavity and paranasal sinuses, intracranial hypertension.

Contraindications of Paracetamol include: liver or kidney failure, anemic condition, low white blood cell count and elevated blood bilirubin levels, age of the child under two months.

Side effects Antipyretics for children

According to the instructions, Paracetamol can have side effects such as: headaches, liver dysfunction, nausea and vomiting, difficulty breathing, sleep disturbance and nervous excitement. The drug may also cause skin reactions.

Ibuprofen, its synonyms and analogs (i.e. NSAIDs with other active ingredients that act in a similar way) may cause headache and dizziness, nausea and vomiting, stomach upset with pain/spasms in the epigastric region, digestive disorders with flatulence and diarrhea (or constipation), increased or decreased BP, bronchial spasm, skin rashes.

Overdose

In case of excess dosage of Paracetamol there may be a sharp increase in the level of abnormal hemoglobin (methemoglobin) in the blood and a decrease in the level of platelets and granular leukocytes (granulocytes), hemolysis of erythrocytes up to anemia, as well as serious impairment of liver function. In case of overdose it is possible Paracetamol poisoning (the antidote is orally administered acetylcysteine).

Ibuprofen overdose is manifested by headache and epigastric pain, dizziness and tinnitus, nausea and vomiting.

Interactions with other drugs

Paracetamol should not be used concomitantly with indirect anticoagulants, non-specific analgesics, anticonvulsants (used in epilepsy), antibiotics of the macrolide group (Erythromycin, Josamycin, Azithromycin).

Ibuprofen should not be combined with taking other NSAIDs, acetylsalicylic acid and anticoagulants, cytostatic drugs (Methotrexate and others).

Storage conditions

Tablet medicines, suspensions and syrups should be stored in a place protected from light at room temperature, suppositories - in the refrigerator.

Shelf life

The shelf life of preparations is indicated on the package and on the label of vials (with syrup or suspension), as a rule, it is three years. Syrups and suspensions after opening the bottle can be used for one month.

Analogs

In addition to tablets, syrups and suspensions with Ibuprofen or Paracetamol, you can give antipyretic tea for children - with peppermint or raspberry leaves, ginger root or dried black elderflowers. For more information, see. - Teas for colds

You can also brew antipyretic herbs for children: linden and chamomile flowers, herbs of lemon balm or melissa, angelica root (dudnik). More information in the article - How to bring down fever with folk remedies and herbs?

But the antipyretic patch for children is not actually a medicine, i.e. It cannot reduce a child's high body temperature. For example, the cooling patch Koolfever (Kobayashi Pharmaceutical Co., Ltd., Japan) effectively dissipates heat on the area of the skin where it is applied (and it is recommended to apply it to areas of the body with blood vessels close to the surface of the skin). So the patch does not have a cooling effect on the whole body.

The main ingredient of the patch is not an antipyretic medication, but a hydrogel (a water insoluble polymer) that absorbs a large amount of moisture in the area of application to the skin. And once the patch is removed, the skin will quickly warm back to its original temperature.

Literature

• Belousov, Y. B. Clinical pharmacology : national guide / edited by Y. B. Belousov, V. G. Kukes, V. K. Lepakhin, V. I. Petrov - Moscow : GEOTAR-Media, 2014.
• Baranov, A. A. Pediatrics: National Manual. Brief edition / ed. By A. A. Baranov. - Moscow : GEOTAR-Media, 2015. - 768 с.