Thursday, October 29, 2020


國人對於兒童發熱及退熱藥物的應用存在很多誤區,這裡引用美國兒科學會(American Academy of Pediatrics)的《兒童發熱與退熱藥物應用》(Fever and Antipyretic Use in Children)中的部分內容,供大家參考。

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.

譯文:使用布洛芬來治療持續升溫的發熱患兒是因為它似乎具有更加長效的降溫效果(表1)。研究中,布洛芬和對乙酰氨基酚的效果進行了比較,並得出了不同的結果;共識是這兩種藥物在降溫方面比安慰劑組更有效,同時布洛芬(10mg/kg)與對乙酰氨基酚(15mg/kg)相比,在單獨使用或者是重複使用時至少一樣有效甚至更加有效。數據還表明,發熱程度和兒童的年齡(而不是所使用的特定的藥物)可能為影響退熱藥物治療發熱療效的主要決定因素;對於 6 歲以上的較高體溫的發熱兒童而言,他們對於退熱藥物的治療效果會有所下降。

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.


條目 對乙酰氨基酚 布洛芬
溫度下降(°C) 1–2 1–2
生效時間(小時) <1 <1
藥物峰值時間(小時) 3–4 3–4
效果持續時間(小時) 4–6 6–8
劑量(mg/kg) 10–15 every 4 h 10 every 6 h
每日最大劑量(mg/kg) 90 mg/kg ↵a 40 mg/kg
成人每日最大劑量(g/d) 4 2.4
年齡下限(月) ↵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. 兒科病症多為呼吸性疾病,從而導致了發熱癥狀。

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