Is Combining or Altering Antipyretic Therapy More Beneficial than Monotherapy for Children with Fever?

Reflective Evidence-Based Case Study: Is Combining or Altering Antipyretic Therapy More Beneficial than Monotherapy for Children with Fever?

Case ScenarioA 2-year-old girl presented with fever, cold and cough for three days. All symptoms started on the same day one after another, with high fever at the onset. The fever would respond to paracetamol for 45 hours and then rise again. The fever had shown a downward trend on day 1 and was normal by day 2, with the cold and cough also getting better. However, after being afebrile for a day, the girl had another spike of fever up to 1000F. The mother mentioned that this was the third visit to pediatrics emergency in the last two days with the same fever. Otherwise, the baby has a healthy normal pattern of activity and good fed. Clinical examinations revealed, Comfortable and well-oriented, Well-nourished, Temperature: 1000F and normal systemic examinations. Investigation shown, Hb: 12.2 gm%, TLC: 8,400/cumm, and Platelets: 2,45,000/cumm.

IntroductionFever in a child is one of the most common clinical symptoms managed by pediatricians and other healthcare 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 first 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. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized.

Objectives of the Case AnalysisQuestions regarding whether the combination or alteration of antipyretic is preferred over the use of monotherapy among children with fever remains one of the key concerns in healthcare delivery. There is a need for a clear understanding of the antipyretics strategies that may help to reduce cases of repetitive fever diagnosis among children. In this paper, the analysis carried out concerning the above case scenario seeks to unravel the goals of and approaches to fever management based on scholarly evidence to enhance the efficiency of the pediatric emergency physicians. Therefore, the following key objectives have informed this analysis.

To identify current fever management strategies and their basis, and to assess the frequency of alternating acetaminophen and ibuprofen

To evaluate the evidence surrounding the safety and effectiveness of paracetamol and ibuprofen in the care of a healthy child with fever To determine the purpose of antipyretics administration during fever in children

To determine the preferred method of antipyretics administration

To assess the effects and side effects of combining paracetamol and ibuprofen, or alternating them on consecutive treatments, compared with monotherapy for treating fever in children

Current Fever Management Strategies: Alternating Acetaminophen and IbuprofenPaediatrics physicians use different methods such as rectal, oral, auxiliary, infrared, and the use of smartphones to determine the body temperature in children. Temperature depicting abnormal elevations emanating from biological responses is regarded as fever, which calls for physician intervention. The regular body temperature is considered at an average of 370 C with a variation of +10 C or -10 C. However, the case of temperature above the average are common and may be categorized as normal or abnormal depending on the age of a child and the health condition, which prompts clinical assessment. Although clinical diagnosis such as immune deficiency may be detected, worth noting are the other signs such as irritability and meningismus that could hint the existence of other complex diseases (Baraff, 1991; Dagan et al., 1988).

The temperature homeostasis mechanisms regulate the body temperature; however, the pathogenesis evidence relates fever with the of synthesis of Tumor Necrosis Factor, Interleukin, and Interferon. When the upper limit ( 420 C/1070 F) of fever is reached, there is a need for fever management. Efficient management of fever calls for the establishment of the cause, which is followed by the need for improving the comfort of the child (Sullivan and Farrar, 2011). Since fever could be harmful or not, consulting health care practitioners is important. The necessity of education for the parent is part of the preventive process (El-Radhi, 2008). The use of anticipatory guidance offers the best platform for the management of fever in children; however, the use of antipyretic agents in essential when there is a need for the restoration of the thermoregulatory set-point (Sullivan and Farrar, 2011, El-Radhi, 2008).

Worth pointing out is that the medical evidence-based analysis affirms how the treatment of hyperthermia is different from the strategies used to manage fever. Cases of exacerbated liver complexities for children with heat stroke when using antipyretic medications have been identified. However, in cases regarding fever in children, acetaminophen should be avoided when the child has liver failure. On the other hand, the use of Ibuprofen is associated with enhanced antiplatelets effect for selective serotonin reuptake inhibition. Therefore, the use of acetaminophen is recommended as an antipyretic therapy in cases where there are limited medical conditions. However, the use of ibuprofen is effective when the anti-inflammatory and antipyresis advantages are needed. Moreover, both ibuprofen and acetaminophen are more efficient when seeking to reduce body temperature when compared to the use of placebo; nevertheless, ibuprofen is more effective than acetaminophen, but the latter is safe in line with the dosage (Ward, 2014; Wilson et al., 1991; Perrott et al., 2004).

Furthermore, combining and alternating ibuprofen and acetaminophen is another strategy that is widely adopted in fever management. However, this approach is associated with the toxicity effect and escalation of fever phobia (Sullivan and Farrar, 2011). Nevertheless, scholarly evidence affirms how the combination of the two medication is more effective than when treatment is based on either of the regimens. On the other hand, continuity in temperature elevation in children three to four hours after the administration of either ibuprofen or acetaminophen calls for the switching of the medication. In such a case the physician could recommend changing from ibuprofen to acetaminophen and vice versa (Ward, 2014; Trautner et al., 2006).

Safety and Effectiveness of Paracetamol and IbuprofenAlthough the clinical analysis has focused on the use of acetaminophen and ibuprofen when dealing with a fever in children, the use of paracetamol provides another dimension of analysis. Paediatrics and other physicians, the use of ibuprofen as well as paracetamol is preferred when dealing with moderate and mild pain. The continuity of pain has been associated with the shifting from one agent to another and finally the alteration of when the pain persists. Evidence from multiple clinical research indicates that both ibuprofen and paracetamol are prescribed as analgesics, but paracetamol is considered safe and efficient for fever among pediatric patients as well as adults. However, for the management of pain and inflammatory instances, ibuprofen is commonly used. Nevertheless, paracetamol is considered as the next switch when the treatment response for ibuprofen is not significant. Rainsford et al. (1997) concluded that both ibuprofen and paracetamol are undercover agents for fever and pain management for pediatric and adult patients. The analysis revealed that the adverse effect was witnessed among 10% and 8% of the patients involved in the study for paracetamol and ibuprofen respectively. Moreover, evidence shows that paracetamol is linked to better GI renal and respiratory safety when compared to ibuprofen; however, the latter is preferred to aspirin because of the GI safety indicators (Southey et al., 2009). Specific safety issues have been based on the gastrointestinal effects, asthma, cardiovascular indications in ibuprofen, and hepatotoxicity in paracetamol (Alander et al., 2000).

Purpose of Antipyretics Administration During Fever in ChildrenCases of parent and caregivers treating fever in children are common; however, there is a need for a clear understanding of the purpose of antipyretics administration in children. The commonly used antipyretics as noted above include acetaminophen and ibuprofen. The use of aspirin is not recommended because of the interrelation with the Reye Syndrome (Sullivan and Farrar, 2011). Nevertheless, the objective of administering antipyretic agents is the reduction of the childs discomfort. In such a case, the analysis and treatment should be carried out on an individual-based assessment to avoid generalization. A case-by-case approach is necessary because it provides the best platform for the evaluation of the fever curve (Ward, 2014). On the other hand, the purpose of antipyretics administration should not be founded on the need to reduce fever in febrile illness to control the rate of morbidity and mortality. Moreover, there are not evidence-based clinical recommendations associating the use of antipyretic agents and the reduced seizures in febrile illness cases (Sullivan and Farrar, 2011). Therefore, the focus of fever management in children should be the need to lessen the discomfort that the child is experiencing as well as reducing the loss of water. Having a wrong objective for antipyretics administration could impede the identification of causative disease and the possibility of toxins emanating from drugs (Sullivan and Farrar, 2011).

Preferred Method of Antipyretics AdministrationOral administration is the preferred method for the antipyretic-based fever treatment. The use of acetaminophen is based on the dosage of 10 to 15 mg/kg 4 6 hours. However, the maximum daily dose is capped at 75 mg/kg in each day, but this can extend up to 4 g/day. Nevertheless, the need to reduce the possibility of dosage confusion it is essential for the oral administration to be restricted to 30 mg/kg. Such an approach is expected to ignite change within the first half or one hour after the first administration (Sullivan and Farrar, 2011). On the other hand, the use of ibuprofen is essential when antipyretic as well as anti-inflammatory advantages are needed. Such a scenario is critical in cases associated with juvenile arthritis (Ward, 2014). The recommended dosage is set at 10 mg/kg with a maximum of 600 mg. Ibuprofen should also be administered orally after ev...