Fever in Children. Italian Pediatric Society Guidelines 2016. 17-32.
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Recommendation 17: Oral administration of paracetamol is preferable to rectal administration in children, because absorption is more constant and it is possible to achieve a more precise dosage based on body weight (evidence level I; strength of recommendation A).
Recommendation 18: Rectal administration should be considered only in the presence of vomiting or other conditions that prevent oral administration (evidence level I; strength of recommendation A).
Recommendation 19: Use of rectal doses of paracetamol that exceed the standard dose should be avoided in children due to the increased risk of toxicity (evidence level I; strength of recommendation E).
Recommendation 20: The rectal dose should be based on the child’s weight rather than age. If the dose provided by commercially available suppositories would exceed the appropriate weight-based dose, another route of administration should be used (evidence level I; strength of recommendation A).
Recommendation 21: Paracetamol and ibuprofen are generally well tolerated and effective antipyretics when used at the recommended dosage. For oral paracetamol, the standard dosage is 10 to 15 mg/kg per dose (maximum, 1 g per dose) given 4 to 6 times daily (ie, q 4–6h). The maximum therapeutic doses are 60 mg/kg per day in children aged < 3 months and 80 mg/kg per day in children aged ≥ 3 months (maximum, 3 g/d), and the toxic dose is > 150 mg/kg in a single administration. For oral ibuprofen, the standard dosage is 10 mg/kg per dose (maximum, 800 mg per dose) given 3 or 4 times daily (ie, q 6–8h). The maximum therapeutic dose is 30 mg/kg per day (maximum, 1.2 g/d), and the toxic dose is >100 mg/kg per day (evidence level I; strength of recommendation A).
Recommendation 22: Use of ibuprofen is not recommended in children with chickenpox or dehydration (evidence level V; strength of recommendation D).
Recommendation 23: Until further data are available, use of ibuprofen is not recommended in children with Kawasaki disease receiving acetylsalicylic acid therapy because of the risk of reduced anti-aggregating efficacy of acetylsalicylic acid (evidence level V; strength of recommendation D).
Recommendation 24: Doses should be administered using the measuring device provided with the drug package (evidence level V; strength of recommendation A).
Recommendation 26: When antipyretic toxicity is suspected, the child should be referred immediately to a poison treatment center or emergency department, as prompt intervention is associated with a better prognosis (evidence level I; strength of recommendation A).
Recommendation 27: Use of ibuprofen and paracetamol is not contraindicated in febrile children with asthma. Paracetamol and ibuprofen are contraindicated in known cases of paracetamol- or NSAIDinduced asthma (evidence level I; strength of recommendation A).
Recommendation 28: There is insufficient evidence to evaluate the use of paracetamol and ibuprofen in febrile children with other chronic pathologies (ie, malnutrition, chronic cardiopathy, and chronic hepatopathy). Caution is warranted in cases of severe hepatic or renal failure/dysfunction or in children with severe malnutrition (evidence level III; strength of recommendation C).
Recommendation 29: Febrile newborns aged < 28 days should always be hospitalized due to the elevated risk of severe disease (evidence level I; strength of recommendation A).
Recommendation 30: Paracetamol is the only antipyretic indicated for use in newborns. The dose and frequency of administration in newborns should be adjusted based on gestational age (evidence level III; strength of recommendation A).
Recommendation 31: Use of paracetamol or ibuprofen is not recommended to reduce the incidence of fever and local reactions in children undergoing vaccination (evidence level II; strength of recommendation E).
Recommendation 32: Preventive use of paracetamol or ibuprofen is not recommended for the prevention of febrile convulsions in febrile children (evidence level I; strength of recommendation E).