Question 2: Does a failure to respond to antipyretics predict serious illness in children with a fever?

@article{King2013Question2D,
  title={Question 2: Does a failure to respond to antipyretics predict serious illness in children with a fever?},
  author={D. King},
  journal={Archives of Disease in Childhood},
  year={2013},
  volume={98},
  pages={644 - 646}
}
  • D. King
  • Published 2013
  • Medicine
  • Archives of Disease in Childhood
You are a senior house officer (SHO) working in a busy district general hospital. A 9-month-old boy is brought in by his parents with a fever of 2 days duration. There is no obvious focus but the child appears well. A urine dipstick is negative. When reviewing the child, the registrar is concerned to learn that the fever has not responded to paracetamol (acetaminophen). You wonder if there is any evidence that a febrile child is more likely to have a serious illness if their fever fails to… Expand
Fever in Children: Pearls and Pitfalls
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The epidemiology and measurement of fever, the meaning of fever and associated clinical signs in children of different ages and under special conditions are reviewed, including fever in children with cognitive impairment, recurrent fevers, and fever of unknown origin. Expand
Fever response to ibuprofen in viral and bacterial childhood infections.
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Fever response to Ibuprofen administration is not indicative of serious bacterial infections in children under 4 years of age, and a larger prospective study is required to define whether the lack of response to ib uprofen has any impact on the management of febrile children. Expand
Paracetamol: a focus for the general pediatrician
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Although frequently prescribed, the concept of “effect compartment concentration” and the possible co-factors that could cause toxicity at recommended doses are not familiar to all pediatricians and general practitioners. Expand

References

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Childhood fever: correlation of diagnosis with temperature response to acetaminophen.
TLDR
It is concluded that fever response to acetaminophen is not a clinically useful indicator by which to differentiate the causes of febrile illnesses in young children. Expand
Relationship of bacteremia to antipyretic therapy in febrile children
TLDR
It is concluded that lack of fever response to antipyretics is not a clinical marker for bacteremia in children. Expand
Temperature response to acetaminophen and risk of occult bacteremia: a case-control study.
TLDR
It is concluded that children who do not respond to acetaminophen by at least a 0.8 degrees C decrease in temperature have an increased risk of occult bacteremia, however, achieving a response toacetaminophen does not eliminate the possibility that the child has occult b acteremia. Expand
Temperature response to antipyretic therapy in children: relationship to occult bacteremia.
TLDR
It is concluded that response to antipyretic therapy does not distinguish children who are bacteremic from those who are not, and the mean decrease in temperature for each was similar. Expand
Correlating Changes in Body Temperature With Infectious Outcome in Febrile Children Who Receive Acetaminophen
TLDR
Highly febrile young children with and without invasive bacterial infections who receive a therapeutic dose of acetaminophen experience a significant temperature drop after 60 to 90 min but do not commonly defervesce to an afebrile state. Expand
Diagnostic tests for occult bacteremia: temperature response to acetaminophen versus WBC count.
TLDR
The conclusion reached was that temperature response to acetaminophen has predictive values that are similar to the WBC count, and it may provide useful information, but neither test is impressive, and the clinician cannot reliably predict which febrile children are at risk. Expand
FPIN's Clinical Inquiries. Aspirin use in children for fever or viral syndromes.
TLDR
Aspirin use in children younger than 19 years should be limited to diseases in which aspirin has a proven benefit, such as Kawasaki disease and the juvenile arthritides. Expand
Fever response to acetaminophen in viral vs. bacterial infections.
TLDR
There is no correlation between a child's fever response to acetaminophen and the etiology of the fever, and the difference was found to be statistically insignificant. Expand
Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial
TLDR
Parents, nurses, pharmacists, and doctors wanting to use medicines to supplement physical measures to maximise the time that children spend without fever should use ibuprofen first and consider the relative benefits and risks of using paracetamol plus ib uprofen over 24 hours. Expand
Severity of disease correlated with fever reduction in febrile infants.
TLDR
It was concluded that clinical improvement with defervescence is not a reliable indicator of the presence of occult bacteremia, and routine administration of acetaminophen may interfere with the clinical evaluation by the physician. Expand
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