A5V4d

hours. [new 2013]
Number Research recommendations
Antipyretics
Management by the paediatric specialist
RR 6 The GDG recommends that studies are conducted in primary care and secondary
care to determine whether examination or re-examination after a dose of antipyretic
medication is of benefit in differentiating children with serious illness from those with
other conditions. [2007]
Why this is important
Antipyretic medications are widely used in primary and secondary settings by
parents and healthcare professionals. Children may therefore present to healthcare
facilities having had a dose of antipyretics. Furthermore, the child's response to
antipyretic drugs may be used as an indication of severity of illness, the rationale
being that those with milder illness will either show greater improvement in condition
or a greater reduction in their fever than children with more serious illnesses.
However, it is not clear if such changes in condition are a valid and reliable method
of differentiating children with serious illness from those with less serious conditions.
8.4 Immediate treatment by the paediatric specialist
Some children with fever have life-threatening serious illness which requires immediate treatment to
improve their chances of survival. These treatments will be:
directed against the causative organism (antibiotics, aciclovir)
directed against the consequences of the infection, such as shock or respiratory failure
(intravenous fluids, oxygen)
directed against the inflammation caused by the infection (corticosteroids).
Many of these immediate treatments are endorsed in paediatric advanced life support courses and
are therefore commonly used in the UK. Specific guidance for the immediate treatment of suspected
meningococcal disease was also considered.
Review question
For children with symptoms and signs of a serious illness what immediate treatments improve their
outcome?
Evidence of the effect of the following interventions in the treatment of serious illness was looked for:
intravenous fluids
steroids
antibiotics
aciclovir
oxygen.
Intravenous fluids
Narrative evidence
Two systematic reviews (SRs) and three randomised controlled trials (RCTs) which looked at the use
of intravenous fluids as immediate treatments were identified.
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