Saturday, March 24, 2018


国人对于儿童发热及退热药物的应用存在很多误区,这里引用美国儿科学会(American Academy of Pediatrics)的《儿童发热与退热药物应用》(Fever and Antipyretic Use in Children)中的部分内容,供大家参考。

Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a “normal” temperature. Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child’s overall comfort rather than focus on the normalization of body temperature.


Parents are frequently concerned with the need to maintain a “normal” temperature in their ill child. Many parents administer antipyretics even though there is either minimal or no fever. Approximately one-half of parents consider a temperature of less than 38°C (100.4°F) to be a fever, and 25% of caregivers would give antipyretics for temperatures of less than 37.8°C (100°F). Furthermore, 85% of parents (n = 340) reported awakening their child from sleep to give antipyretics. Unfortunately, as many as one-half of parents administer incorrect doses of antipyretics; approximately 15% of parents give supratherapeutic doses of acetaminophen or ibuprofen. Caregivers who understand that dosing should be based on weight rather than age or height of fever are much less likely to give an incorrect dose.


Physicians and nurses are the primary source of information on fever management for parents and caregivers, although there are some disparities between the views of parents and physicians regarding antipyretic treatment. The most common indications for initiating antipyretic therapy by pediatricians are a temperature higher than 38.3°C (101°F) and improving the child’s overall comfort. Although only 13% of pediatricians specifically cite discomfort as the primary indication for antipyretic use, this intent is generally implied in their recommendations. Most pediatricians (80%) believe that a sleeping ill child should not be awakened solely to be given antipyretics.


It should be emphasized that fever is not an illness but is, in fact, a physiologic mechanism that has beneficial effects in fighting infection. Fever retards the growth and reproduction of bacteria and viruses, enhances neutrophil production and T-lymphocyte proliferation, and aids in the body’s acute-phase reaction. The degree of fever does not always correlate with the severity of illness. Most fevers are of short duration, are benign, and may actually protect the host. Data show beneficial effects on certain components of the immune system in fever, and limited data have revealed that fever actually helps the body recover more quickly from viral infections, although the fever may result in discomfort in children. Evidence is inconclusive as to whether treating with antipyretics, particularly ibuprofen alone or in combination with acetaminophen, increases the risks of complications with certain types of infections. Potential benefits of fever reduction include relief of patient discomfort and reduction of insensible water loss, which may decrease the occurrence of dehydration. Risks of lowering fever include delayed identification of the underlying diagnosis and initiation of appropriate treatment and drug toxicity.


A discussion of the use of antipyretics in febrile children must begin with consideration of the therapeutic end points. When counseling families, physicians should emphasize the child’s comfort and signs of serious illness rather than emphasizing normothermia. A primary goal of treating the febrile child should be to improve the child’s overall comfort. Most pediatricians observe, with some supporting data from research, that febrile children have altered activity, sleep, and behavior in addition to decreased oral intake. Unfortunately, there is a paucity of clinical research addressing the extent to which antipyretics improve discomfort associated with fever or illness. It is not clear whether comfort improves with a normalized temperature, because external cooling measures, such as tepid sponge baths, can lower the body temperature without improving comfort. The use of alcohol baths is not an appropriate cooling method, because there have been reported adverse events associated with systemic absorption of alcohol. Furthermore, antipyretics have other clinical outcomes, including analgesia, which may enhance their overall clinical effect. Regardless of the exact mechanism of action, many physicians continue to encourage the use of antipyretics with the belief that most of the benefits are the result of improved comfort and the accompanying improvements in activity and feeding, less irritability, and a more reliable sense of the child’s overall clinical condition. Because these are the most important benefits of antipyretic therapy, it is of paramount importance that parental counseling focus on monitoring of activity, observing for signs of serious illness, and appropriate fluid intake to maintain hydration.


After sufficient evidence emerged of an association between salicylates and Reye syndrome, acetaminophen essentially replaced aspirin as the primary treatment of fever. 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 (Table 1).


The use of ibuprofen to manage fever has been increasing, because it seems to have a longer clinical effect related to lowering of the body temperature (Table 1). Studies in which the effectiveness of ibuprofen and acetaminophen were compared have yielded variable results; the consensus is that both drugs are more effective than placebo in reducing fever and that ibuprofen (10 mg/kg per dose) is at least as effective as, and perhaps more effective than, acetaminophen (15 mg/kg per dose) in lowering body temperature when either drug is given as a single or repetitive dose. Data also show that the height of the fever and the age of the child (rather than the specific medication used) may be the primary determinants of the efficacy of antipyretic therapy; those who have a higher fever and are older than 6 years show decreased efficacy or response to antipyretic therapy. Studies that compare the effect of ibuprofen versus acetaminophen on children’s behavior and comfort are generally lacking.

译文:使用布洛芬来治疗持续升温的发热患儿是因为它似乎具有更加长效的降温效果(表1)。研究中,布洛芬和对乙酰氨基酚的效果进行了比较,并得出了不同的结果;共识是这两种药物在降温方面比安慰剂组更有效,同时布洛芬(10mg/kg)与对乙酰氨基酚(15mg/kg)相比,在单独使用或者是重复使用时至少一样有效甚至更加有效。数据还表明,发热程度和儿童的年龄(而不是所使用的特定的药物)可能为影响退热药物治疗发热疗效的主要决定因素;对于 6 岁以上的较高体温的发热儿童而言,他们对于退热药物的治疗效果会有所下降。

Antipyretic Information

Variable Acetaminophen Ibuprofen
Decline in temperature, °C 1–2 1–2
Time to onset, h <1 <1
Time to peak effect, h 3–4 3–4
Duration of effect, h 4–6 6–8
Dose, mg/kg 10–15 every 4 h 10 every 6 h
Maximum daily dose, mg/kg 90 mg/kg ↵a 40 mg/kg
Maximum daily adult dose, g/d 4 2.4
Lower age limit, mo ↵b 3 6

Data represent approximate averages from referenced sources.42,43,52,54,71,82

↵a Label is for 75 mg/kg; 90 mg/kg per day should be limited to less than 3 consecutive days.83,–,85

↵b Unless specifically recommended by a health care provider for the younger patient and, then, only after the infant has been examined by a health care provider.


条目 对乙酰氨基酚 布洛芬
温度下降, °C 1–2 1–2
生效时间, h <1 <1
药物峰值时间, h 3–4 3–4
效果持续时间, h 4–6 6–8
剂量, mg/kg 10–15 every 4 h 10 every 6 h
每日最大剂量, mg/kg 90 mg/kg ↵a 40 mg/kg
成人每日最大剂量, g/d 4 2.4
年龄下限, mo ↵b 3 6

Data represent approximate averages from referenced sources.

↵a Label is for 75 mg/kg; 90 mg/kg per day should be limited to less than 3 consecutive days.

↵b Unless specifically recommended by a health care provider for the younger patient and, then, only after the infant has been examined by a health care provider.



One comment

  1. 儿科病症多为呼吸性疾病,从而导致了发热症状。

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