Treatment of Fever

By: Ahmed Mohammed

Eweidah No. 13

Faculty of Medicine, Alexandria University

Rx of Fever

Non Pharmacological Pharmacological

Treatment of Fever

Use tap or lukewarm water (29° to 32° C) to sponge. Remove clothing's, cover the child with towel sponge and dry his face.

Apply the compresses to forehead, nape of neck, armpits and groin.

Treatment of Fever

TEPID SPONGING

Proceed to sponge body starting with the front then to the back.

Generally you should not sponge a child for more than 30 minutes at a stretch. Stop sponging when shivering occurs. When your child shivers, cover him up and wait a while before resuming sponging.

Usually sponging will bring down the fever by one to two degrees in 30-45 minutes.

Treatment of Fever

Encouraging the child to take plenty of fluids.

Dressing the child in light clothing to allow heat exchange.

Room environment is kept cool and well-ventilated to allow the ambient

temperature to help bring the fever down.

Treatment of Fever

Other Measures

There are various reasons why we do not recommend using tepid sponging:

there is a lack of evidence to support its routine use in temperate climates, because the sponging does not produce a sustained drop in temperature

It can lead to vasoconstriction, which can result in a further rise in a child’s temperature.

Treatment of Fever

If performed too quickly, sponging can cause a child to shiver and have an increase in metabolic rate.

The process is also very time-consuming for a nurse or caregiver.

Treatment of Fever

Sponging is preferred

over acetaminophen

or ibuprofen if:

The child is known to be allergic to, or is unable to tolerate, antipyretic drugs (a rare case).

Treatment of Fever

It is advisable to combine sponging with: acetaminophen or ibuprofen if:- Fever is making the child extremely uncomfortable. - He is vomiting and may not be able to keep the medication in his stomach.

Treatment of Fever

Treatment of Fever

Pharmacological

Aspirin Acetaminophen Ibuprofen

The American Academy of Pediatrics has recommended that children (through 21 years of age) not take aspirin if they have chickenpox or influenza (any cold, cough or sore throat symptoms).

Treatment of Fever

Avoid Aspirin

Children older than 2 months of age can be given any one of the acetaminophen products. All have the same dosage.

Acetaminophen doses of 10 to 15 mg/kg per dose given every 4 to 6 hours orally are generally regarded as safe and effective. Typically, the onset of an antipyretic effect is within 30 to 60 minutes; approximately 80% of

children will experience a decreased temperature within that time.

Treatment of Fever

Acetaminophen (APAP)

Treatment of Fever

Nausea, upper stomach pain, itching, loss of appetite.

Dark urine, clay-colored stools. Jaundice (yellowing of the skin or eyes).

Treatment of Fever

Side Effects

All ibuprofen products are now available without a prescription. Give the correct dosage every 6 to 8 hours as needed.

Greater than 6 months to 12 years:5 mg/kg/dose for temperature less than (39.2 degrees C) orally every 6 to 8 hours as needed.10 mg/kg/dose for temperature greater than or equal to (39.2 degrees C) orally every 6 to 8 hours as needed.

Treatment of Fever

Ibuprofen Products

Ibuprofen is a non-selective inhibitor of an enzyme called cyclooxygenase (COX), which is required for the synthesis of prostaglandins via the arachidonic acid pathway. COX is needed to convert arachidonic acid to prostaglandin H2 (PGH2) in the body. This PGH2 is then converted to prostaglandins. The inhibition of COX by ibuprofen therefore lowers the level of prostaglandins made by the body.

Treatment of Fever

Mechanism of action

The prostaglandins that are formed from PGH2 are important mediators of sensations such as pain and processes such as fever and inflammation. The antipyretic effects may arise as a result of action on the hypothalamus leading to vasodilation, an increased peripheral blood flow and subsequent heat dissipation.

Treatment of Fever

Mechanism of action

Nausea (feeling sick) Vomiting (being sick) Diarrhea. Indigestion (dyspepsia) Tummy (abdominal) pain.

Treatment of Fever

Common side effects of ibuprofen

According to WHO paracetamol is the drug of first choice.

Ibuprofen is a useful 2nd line drug. No other NSAID including Nimesulide

should be prescribed for children with high grade fever (WHO 1990).

Treatment of Fever

Choice of Antipyretic

Combining these medicines is not recommended for the following reasons:

No added benefit in reducing fever compared with either product used alone. (Reason: both drugs have the same mechanism of action.)

Can cause dosage errors and poisoning (especially if you give one product too frequently).

No need to control fever this closely.

Treatment of Fever

Use both if the fever is over 104° F (40° C) and unresponsive to one medicine alone.

Give a fever medicine every 4 hours (acetaminophen every 8 hours and ibuprofen every 8 hours).

Only alternate medicines for 24 hours or less, than return to a single product.

Treatment of Fever

Alternative therapy