Is combining or alternating antipyretic therapy more beneficial than monotherapy for febrile children?
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3540 (Published 01 October 2009) Cite this as: BMJ 2009;339:b3540
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This is a fascinating topic. I became interested in this having read
the excellent book "Clinical Manual of Fever in Children" by
El-Radhi, Carroll, and Klein (Eds.)
(2009, Springer, 318 p. 26 illus., Hardcover
ISBN: 978-3-540-78597-2) and being a burn surgeon faced on a daily basis
with patients with pyrexia. The big question in burn care is if the
patient is septic or just showing the signs of the inflammatory response
to the burn with re-setting of the hypothalamic set point. Most burn
patients who die, do so because of sepsis and the multi-organ failure it
causes, whilst much morbidity is caused by wound and graft failure due to
infection. This is a serious dilemma to which we devote much time and
scrutiny, for example by having two Consultant-led ward rounds a day to
make sure we identify sepsis in our patients.I suspect (due to the
considerable evidence already in existence both in humans and other
animals) that fever is a beneficial adaptive response. The alternative is
that micro-organisms have evolved to deliberately raise the body
temperature of their hosts to increase their survival and reproduction. If
the former is true then we should not try to reduce core body temperature
and devote our energy to treating the cause of infection. I wonder if we
can ever organise the required trials to answer this very important
question?
Competing interests:
None declared
Competing interests: No competing interests
Nabulsi says, "Although fever is a beneficial host response, it is an
important cause of anxiety for parents and doctors. The quest for
effective treatment has led to new combination regimens of antipyretic
drugs for febrile children."
Surely it is unethical for the medical and pharmaceutical industries
to promote the use of toxic drugs in children to treat anxiety in parents
and doctors?
This article is under the banner, "Education." Rather than educating
the medical fraternity about how to allay their anxiety by giving toxic
drugs to children they should be educated to allow a beneficial host
response to take its natural course and for themselves to take a 'chill
pill.'
Competing interests:
None declared
Competing interests: No competing interests
Paracetamol and Ibuprofen for the treatment of fever in children: the
PITCH randomised controlled trial (Hay)
The Health Technology Assessment project referred to in Note 13 to
this article has now been published as Volume 13, number 27 in the HTA
journal series. It is freely available in pdf format on the HTA website at
this location: http://www.hta.ac.uk/1412
Competing interests:
None declared
Competing interests: No competing interests
Appropriate therapy for a fever
This paper acknowledges that fever is a beneficial response in
infection.
The author then justifies giving anti-pyretics on the basis that "it is an
important cause of anxiety for patients and doctors".
I am concerned that this study will be reported by the popular press and
used as a justification for combined anti-pyretic therapy.
A mild pyrexia (<_40c improves="improves" aspects="aspects" of="of" the="the" immune="immune" system="system" e.g.="e.g." neutrophil="neutrophil" chemotaxis="chemotaxis" and="and" so="so" is="is" an="an" appropriate="appropriate" part="part" bodys="bodys" response="response" to="to" infection.="infection." i="i" do="do" not="not" believe="believe" we="we" should="should" be="be" preventing="preventing" this="this" relieve="relieve" anxiety="anxiety" in="in" parents="parents" or="or" doctors.="doctors." explanation="explanation" how="how" fever="fever" defence="defence" a="a" more="more" rational="rational" approach="approach" p="p"/>Competing interests:
None declared
Competing interests: No competing interests