News & Current Affairs

September 19, 2008

‘Ibuprofen best’ for child fevers

‘Ibuprofen best’ for child fevers

Baby with father

Most symptoms of a fever in young children can be managed at home

Ibuprofen is better at alleviating childhood fever than paracetamol and should be the drug of first choice, say UK researchers.

The Bristol-based trial involving 156 children aged between six months and six years showed ibuprofen reduced temperature faster than paracetamol.

The British Medical Journal work also says alternating the two drugs could help, which some GPs already recommend.

But experts advised against this, in line with official guidance.

The concern is the relative ease with which children could receive an overdose.

Fever is very common in young children, affecting seven in every 10 preschool children each year.

Parents wanting to use medicines to treat young, unwell children with fever should be advised to use ibuprofen first
Lead researcher Dr Alastair Hay

It can be miserable for the child and cause anxiety for parents. Most fevers will settle by themselves but a few are caused by serious infections such as pneumonia.

Guidelines published last year by the National Institute for Health and Clinical Excellence (NICE) say either ibuprofen or paracetamol can be used for children unwell or distressed with fever.

But they say that, due to the lack of evidence, the two drugs should not be given together or alternated.

The researchers from the University of Bristol and the University of the West of England, recruited children who had a temperature between 37.8 and 41 degrees centigrade, due to an illness that could be managed at home.

Alternating drugs

Children were randomised to receive either paracetamol plus ibuprofen, just paracetamol, or just ibuprofen.

The medicines were given over a 48-hour period, with the group of children on both paracetamol and ibuprofen receiving them as separate doses.

This group received one dose of paracetamol every four to six hours (maximum of four doses in 24 hours) and then one dose of ibuprofen every six to eight hours (maximum of three doses in 24 hours).

Childhood fever
A normal temperature is between 36-36.8C (96.8-98.24F)
In children, any temperature of 38C (100.4F) or above is considered high and is called a fever
To find out if your child has a fever, place a thermometer under your child’s armpit or use a special ear thermometer

The children’s condition was followed up at 24 hours, 48 hours and at day five.

The researchers found that in the first four hours children given both medicines spent 55 minutes less time with fever compared to those given paracetamol alone.

But giving two medicines was not markedly better than just giving ibuprofen.

However, over a 24 hour period, children given both medicines experienced 4.4 hours less time with fever than those given just paracetamol, and 2.5 hours less time with fever than those just given ibuprofen.

Safety issues

Dr Alastair Hay, consultant senior lecturer in primary health care at the University of Bristol, who led the study, said: “Doctors, nurses, pharmacists and parents wanting to use medicines to treat young, unwell children with fever should be advised to use ibuprofen first.

“If more sustained symptom control over a 24-hour period is wanted, giving both medicines alternately is better than giving one on its own.

“However, parents should keep a careful record of when doses are given to avoid accidentally giving too much.”

We believe parents should keep it simple. We do not see at this moment any need to change the advice
Professor Steve Fields, chairman of the Royal College of General Practitioners

He said he thought it would be appropriate for NICE to review its guidance in light of the new study, saying the current guidance was too cautious.

In an accompanying editorial in the BMJ, Dr Anthony Harnden from the University of Oxford, warned of the relative ease with which children could receive an overdose.

He said that a “more complicated alternating regimen of paracetamol and ibuprofen may be less safe than using either drug alone”.

A spokeswoman for NICE said the 2007 guidance recommended that more research should be conducted on the effectiveness and safety of alternating doses of paracetamol and ibuprofen in reducing fever in children who remain febrile after the first fever-reducing medicine.

She said: “Any newly published research will need to be thoroughly assessed by independent experts as part of the process of updating clinical guidelines.

“This is essential to ensure that any new evidence is of the highest standards before any potential updates can be made to existing guidance.”

Professor Steve Fields, chairman of the Royal College of General Practitioners, advised parents and carers of children with fever to follow the NICE guidance.

“We believe parents should keep it simple. We do not see at this moment any need to change the advice.

“However, this paper does demonstrate that using ibuprofen initially is more effective at reducing temperature and may demonstrate that using both ibuprofen and paracetamol together could have a positive effect.”

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September 1, 2008

Indian floods cut off thousands

Indian floods cut off thousands

Half a million people in the Indian state of Bihar remain stranded in villages which have been devastated by massive flooding, officials say.

Correspondent reports chaotic scenes as soldiers try to reach those cut off and people attempt to scramble from rooftops into rescue boats.

With 1.2 million people homeless, India is struggling to cope with the crisis.

The flood waters are spreading to new areas, and conditions in relief camps are overcrowded and unsanitary.

The floods are known to have killed at least 75 people in Bihar but the death toll could climb once the situation in remote areas emerges.

Tens of thousands of people have also been displaced in neighboring Nepal where some of those who have lost their homes are camping under plastic sheets.

Disorganization

Visiting the Bageecha relief camp in Purnea, the BBC’s Sanjoy Majumder could find no camp co-ordinator or government official in charge of distributing aid.

map

Trucks and vans carrying relief material stood parked on the highway as volunteers waited to be organised.

Several tonnes of aid had arrived but the volunteers were not quite sure how to distribute it.

The situation was symptomatic of what was happening across Bihar’s flood-affected areas, our correspondent says.

The disaster began on 18 August when a dam burst on the Saptakoshi river in Nepal.

The Saptakoshi, which becomes the Kosi when it enters India, subsequently broke its banks in Bihar.

Officials in Nepal say hundreds of people there have been hit by illnesses such as diarrhoea and pneumonia and an estimated 50,000 are homeless.

They say nearly 1,000 houses have been completely destroyed. Power supplies and transport have been severely affected.

The costs to the economy are now estimated at one billion Nepalese rupees ($14.25m).


Have you been affected by the floods in Bihar? Send us your comments and experiences.

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