Table 3

Specific recommendations

Specific recommendationsAAP2 SIP27 South- Africa30 NICE44 NSW47 SA48 WHO49
Age of target populationNot specified0–18 yearsNot specified<5 years1 month −5 years<3 years<5 years
Indications and treatment goals
 Antipyretics are indicated to improve overall comfort of the febrile child
 Antipyretics should not be used with the aim of reducing body temperaturenr
 Fever response to antipyretics is not a predictor of serious illnessnrnrnr
 Antipyretics do not prevent febrile convulsionsnrnr
 Antipyretics are not indicated to prevent vaccine reactionnrnrnrnr
 Antipyretics are not indicated to treat vaccine reactionnrnrnrnrnrnr
Physical management
 The use of physical devices is not recommendednr nrnr✘*nr✘†
 Children with fever should not be under-dressed or over-wrappednr✘*nr✘†
 The use of alcoholic baths is not an appropriate cooling method nrnr nrnr
 Tepid sponging is not recommended for the treatment of fever nrnr
Pharmacological management
 Consider using either paracetamol or ibuprofen in children with fever who appear distressed
 Paracetamol from the age of3 months‡Birth§3 monthsnrBirthBirth§2 months
 Ibuprofen from the age of6 monthsnr3 monthsnr6 months2 months
 Paracetamol oral dose (mg/kg/dose)10–15
(Sup. table 1)
10–15
(Sup. table 1)
15
(Sup. table 1)
nr15
(Sup. table 1)
15
(Sup. table 1)
10–15
(Sup. table 1)
 Paracetamol dose in newborns (mg/kg/dose)nr– 10 (<32 weeks)
– 10–15 (>32 weeks)
(Sup. table 2)
nrnrnr15
(Sup. table 2)
 Initial loading dose of paracetamol (oral, rectal) is not recommended nrnrnrnrnrnr
 Ibuprofen dose mg/kg/dose1010
(Sup. table 3)
10
(Sup. table 3)
nr10
(Sup. table 3)
5–10
(Sup. table 3)
5–10
(Sup. table 3)
 Combination of paracetamol/ibuprofen is not recommended✘¶nrnr
 Alternating paracetamol/ibuprofen is not recommended✘¶✘**✘**nr
 Oral administration of paracetamol is preferred to rectalnr nrnrnrnrnr
 Rectal administration is allowed only if the oral is not feasiblenr nrnrnrnrnr
 Mefenamic acid from 6 months of age may be an alternative to ibuprofen in children with fevernrnr nrnrnrnr
 Doses have to be calculated on weight, not on agenr nrnrnrnr
 Avoid combination of antipyretics and ‘cough and cold medicines’ nrnrnrnr
 Use only the measuring device providednr nrnrnrnr
Contraindications/precautions
 Ibuprofen does not seem to worsen asthma symptoms✔††CautionnrnrCautionnr
 Paracetamol does not seem to worsen asthma symptoms nr nrnrnr
 Ibuprofen is indicated in children with dehydrationCautionCautionNot conclusivenrCautionnr
 Ibuprofen is indicated in children with varicellaCautionCautionNot conclusivenrnrnr
 Caution using antipyretics in other chronic diseases nrnrnrnr
Intoxication
 In the case of suspected poisoning with paracetamol take the child to emergency department or poison centrenr nrnrnrnr✔‡‡
  • ✔agree; ✘disagree; nr, not reported; Sup. table: supplementary table.

  • *Unwrapping an overdressed child is appropriate.47

  • †Undressing the child t is recommended to reduce the fever.49

  • ‡In children <3 months it can be administered only after medical advice.2

  • §In children <3 months it can be administered by adapting the dosage and intervals to the gestational age.47 48

  • ¶Insufficient evidence to support or refuse the routine use of combination treatment.2

  • **Alternating the two drugs is possible if discomfort persists or recurs using only one antipyretic.44 48

  • ††Ibuprofen is contraindicated in known cases of asthma related to non-steroidal anti-inflammatory drugs.27

  • ‡‡Management of paracetamol intoxication is reported in chapter 1: Triage and emergency conditions/common poisoning.49

  • AAP, American Academy of Pediatrics; NICE, National Institute for Health and Care Excellence; NSW, New South Wales Ministry of Health; SA, South Australian Ministry of Health; SIP, Italian Pediatric Society.