Antipyretics

Antipyretic efficacy of indomethacin and acetaminophen in uncomplicated falciparum malaria

The efficacy of indomethacin and acetaminophen as antipyretics was compared in 43 febrile patients with uncomplicated falciparum malaria. Each patient was randomly assigned to receive low oral doses of indomethacin (25 mg three times a day) or acetaminophen (1000 mg four times a day) as well as mefloquine. Oral temperature was measured before dosing and then every 4 h until apyrexia. Indomethacin was significantly quicker at clearing fever than acetaminophen (P < 0.05) and at reducing excessively high fever (> or = 39 degrees C) to a safer range (< 39 degrees C). No adverse effects were observed in either treatment group. The study shows that indomethacin is a potent antipyretic agent. It appears to be a safe alternative to acetaminophen for the treatment of febrile malarial patients who may benefit from antipyretic medication, including those unresponsive to treatment with acetaminophen.

Acetaminophen (paracetamol) in the management of burned children with fever

Acetaminophen (paracetamol 12 mg/kg p.o.) was administered on a total of 33 occasions to 12 children (13-36 months of age) during the first 60 h after burn injury covering 10-44 per cent of the body surface area (BSA). The drug was effective in lowering rectal temperature on most (80 per cent) occasions; failure to elicit a response was not restricted to particular patients or patterns of injury. There was no evidence of tachyphylaxis to the antipyretic effects of acetaminophen. The pattern of change in the rectal and toe temperature after acetaminophen suggested that it may be acting by either increasing heat loss or by lowering heat production, both of which are consistent with a reduction in thermoregulatory setpoint mediated by inhibition of prostaglandin synthetase.

Aspirin dosage for infants and children

The labeled dosage schedule that has long been on pediatric aspirin preparations is at variance with the recommendation in authoritative medical references, studies demonstrating antipyretic effectiveness in children, and the prescribing habits of pediatricians as revealed by a poll conducted by the authors. Aspirin pharmacokinetics are influenced by a number of physiologic factors, as well as by dosage, and complicate the problem of assuring safe and effective pediatric use. Basic pharmacokinetic considerations indicate that the increase in size of individual doses needed to assure therapeutic salicyate blood levels, thereby removing the temptation of parents to administer the drug too often, is made permissible (i.e., safe while effective) by expanding the interdose interval to four hours instead of three. A revised pediatric aspirin disage schedule is presented that better meets the practices of the pediatric community and the needs of consumers.