Farmacoriflessioni
Il trattamento sintomatico della febbre e del dolore nella pratica ambulatoriale
FEDERICO MARCHETTI, JENNY BUA, MASSIMO MASCHIO, EGIDIO BARBI
Clinica Pediatrica, IRCCS “Burlo Garofolo”, Università di Trieste
Gennaio 2005 - pagg. 47 -54
Abstract
Acetaminophen and ibuprofen are the first choice drugs (and in the UK the only authorized
ones) for the treatment of fever and minor pain (earache, arthralgia, headache). There are
several more NSAID molecules which are currently used in paediatric practice, but for none
of them there is evidence of a better cost/benefit or safety and effectiveness profile than for
acetaminophen and ibuprofen (10-15 mg/kg and 4-10 mg/kg pro dose respectively ). These
drugs have few side effects and a similar analgesic effect. Ibuprofen is slightly more effective
on fever and is definitely better for headache. The association acetaminophen and codeine
has an analgesic effect on severe pain such as post-surgical pain, which is double than for
acetaminophen alone and several times greater than for codeine alone.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Narang AS. Fever: to treat or not to treat.
Contepoint. Clin Pediatr 2002;41:9-16.
2. Meremikwu M, Oyo-Ita A. Paracetamol for treating fever in children. Cochrane Database Syst Rev 2002(2):CD003676.
3. Meremikwu M, Oyo-Ita A. Physical methods for treating fever in children. Cochrane Database Syst Rev 2003(2):CD004264.
4. Schnaidermann D, Lahat E, Sheefer T, Adjalem M. Antipyretic effectiveness of acetaminophen in febrile seizures: ongoing prophylaxis versus sporadic usage. Eur J Pediatr 1993;152:747-9.
5. Uhari M, Rantala H, Vainionpää L, Kurttila R. Effect of acetaminophen and of low intermittent doses of diazepam on prevention of recurrences of febrile seizures. J Pediatr 1995; 126: 991-5.
6. van Stuijvenberg M, Derksen-Lubsen G, Steyerberg EW, Habbema JD, Moll HA. Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences. Pediatrics 1998;102 (5):e51.
7. El-Radhi AS, Barry W. Do antipyretics prevent febrile convulsions? Arch Dis Child 2003; 88(7):641-2.
8. Waruiru C, Appleton R. Febrile seizures: an update. Arch Dis Child 2004;89(8):751-6.
9. Pantell RH, Newman TB, Bernzweig J, et al. Management and outcomes of care of fever in early infancy. JAMA 2004;291(10):1203-12.
10. Tanne JH. Children are often undertreated for pain. BMJ 2003;327:1185.
11. Kharasch S, Saxe G, Zuckerman B. Pain treatment: opportunities an challenges. Arch Pediatr Adolesc Med 2003;157:1054-6.
12. Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med 2002;347(14):1094-103.
13. Cazzato T, Pandolfini C, Campi R, Bonati M, e il Gruppo di lavoro dell’ACP Puglia-Basilicata. Attitudini prescrittive nella pediatria di famiglia. Giorn Ital Farm Clin 2001;15:21-5.
14. Rossi E, De Rosa M, Bonati M, et al. La prescrizione farmaceutica pediatrica nell’ambito delle cure primarie. Rapporto della banca dati ARNO. Giorn Ital Farm Clin 2001;15:26-9.
15. Motola D, Vaccheri A, Silvani MC, Poluzzi E, Bottoni A, De Ponti F, Montanaro N. Pattern of NSAID use in the Italian general population: a questionnaire-based survey. Eur J Clin Pharmacol 2004;60(10):731-8.
16. Giusti MP, Marchetti F, Tognoni G, Bonati M. Uso dei FANS in pediatria. Trattamento della febbre e delle infezioni respiratorie acute: una revisione della letteratura. Medico e Bambino 1995;14(6):285-91.
17. Grazi L, Peccarisi C, Bussone G. La cefalea del bambino e dell’adolescente. Medico e Bambino 2003;22(7): 28-31.
18. Addis A, Bonati M. Use of nimesulide in children. Lancet 1999;354:1034.
19. Ministero della Salute. Guida all’uso dei farmaci per i bambini. 1° edizione. Roma, 2003.
20. Russell FM, Shann F, Curtis N, Mullholland K. Evidence on the use of paracetamol in febrile children. Bullettin of the World Health Organization 2003;81:367-72.
21. Wahba H. The antipyretic effect of ibuprofen and acetaminophen in children. Pharmacotherapy 2004;24(2):280-4.
22. Clavenna A, Bonati M. Una “Dear Doctor Letter” per razionalizzare l’uso dei farmaci antiinfiammatori non steroidei (FANS) nei bambini? Giorn Ital Farm Clin 2001;15:36-7.
23. Belay ED, Breese JS, Holman RC, et al. Reye’s syndrome in the United States from 1981 through 1997. N Engl J Med 1999;340: 1377-82.
24. Menniti-Ippolito F, Sagliocca L, Da Cas R, et al. Niflumic acid and cutaneous reactions in children. Arch Dis Child 2001;84(5):430-1.
25. Lesko SM, Mitchell AA. An assessment of the safety of pediatric ibuprofen. JAMA 1995; 273:929-33.
26. Lesko SM, Mitchell AA. The safety of acetaminophen and ibuprofen among children younger than two years old. Pediatrics 1999; 104:39-44.
27. Lesko SM, Louik C, Vezina RM, Mitchell AA. Asthma morbidity after the short-tem use of ibuprofen in children. Pediatrics 2002;109: 1-4.
28. Nimesulide: controindicata al di sotto dei 12 anni. Bollettino d’informazione sui farmaci 1999;3-4:42-3.
29. Traversa G, Bianchi C, Da Cas R, Abraha I, Minneti-Ippolito F, Venegoni M. Cohort study of hepatotoxicity associated with nimesulide and other non-steroidal anti-inflammatory drugs. BMJ 2003;327:18-22.
30. Carvajal A, Macia MA, Garcia del Pozo J. Small risk ratios may have strong public health impact. BMJ 2003;327:1050-1.
31. Heubi JE, Barbacci MB, Zimmerman HJ. Therapeutic misadventures with acetaminophen: hepatotoxicity after multiple doses in children. J Pediatr 1998;132(1):22-7.
32. Bromer MQ, Black M. Acetaminophen hepatotoxicity. Clin Liver Dis 2003;7(2): 351-67.
33. Riordan M, Rylance G, Berry K. Poisoning in children 2: painkillers. Arch Dis Child 2002; 87(5):397-9.
34. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 1999; 340(24):1888-99.
35. Hermaszewski R, Hayllar J, Woo P. Gastroduodenal damage due to non-steroidal anti-inflammatory drugs in children. Br J Rheumatol 1993;32(1):69-72.
36. Mulberg AE, Linz C, Bern E, Tucker L, Verhave M, Grand RJ. Identification of nonsteroidal antiinflammatory drug-induced gastroduodenal injury in children with juvenile rheumatoid arthritis. J Pediatr 1993;122(4): 647-9.
37. Lewis SC, Langman MJ, Laporte JR, Matthews JN, Rawlins MD, Wiholm BE. Doseresponse relationships between individual nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data. Br J Clin Pharmacol 2002;54 (3):320-6.
38. Aronoff DM, Bloch KC. Assessing the relationship between the use of nonsteroidal antiinflammatory drugs and necrotizing fasciitis caused by group A Streptococcus. Medicine (Baltimore) 2003;82(4):225-35.
39. Lesko SM, O’Brien KL, Schwartz B, Vezina R, Mitchell AA. Invasive group A streptococcal infection and nonsteroidal antiinflammatory drug use among children with primary varicella. Pediatrics 2001;107(5):1108-15.
40. Szer IS, Goldenstein-Schainberg C, Kurtin PS. Paucity of renal complications associated with nonsteroidal antiinflammatory drugs in children with chronic arthritis. J Pediatr 1991; 119(5):815-7.
41. Cuzzolin L, Dal Cere M, Fanos V. NSAIDinduced nephrotoxicity from the fetus to the child. Drug Saf 2001;24(1):9-18.
42. Ulinski T, Guigonis V, Dunan O, Bensman A. Acute renal failure after treatment with nonsteroidal anti-inflammatory drugs. Eur J Pediatr 2004;163(3):148-50.
43. Moghal NE, Hegde S, Eastham KM. Ibuprofen and acute renal failure in a toddler. Arch Dis Child 2004;89:276-7.
44. Lantz B, Cochat P, Bouchet JL, Fischbach M. Short-term niflumic-acid-induced acute renal failure in children. Nephrol Dial Transplant 1994;9(9):1234-9.
45. AA.VV. Risks of agranulocytosis and aplastic anemia. A first report of their relation to drug use with special reference to analgesics. The International Agranulocytosis and Aplastic Anemia Study. JAMA 1986;256(13):1749-57.
46. Desikan SR, Meena NG. Do non-steroidal anti-inflammatory drugs increase the risk of bleeding after tonsillectomy? Arch Dis Child 2004;89(5):493-4.
47. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004;328:434.
48. Perrot DA, Piira T, Goodenoguh B, Champion D. Efficacy and safety of acetaminophen vs ibuprofen for treating children’s pain and fever. Arch Pediatr Adolesc Med 2004;158: 521-6.
49. Cummings P. Meta-analysis based on standardized effects is unreliable. Arch Pediatr Adolesc Med 2004;158(6):595-7.
50. Autret E, Breart G, Jonville AP, Courcier S, Lassale C, Goehrs JM. Comparative efficacy and tolerance of ibuprofen syrup and acetaminophen syrup in children with pyrexia associated with infectious diseases and treated with antibiotics. Eur J Clin Pharmacol. 1994; 46(3):197-201.
51. Marchetti F. Ibuprofene in pediatria. Medico e Bambino 2001;20(6):387-91.
52. Autret-Leca E. A general overview of the use of ibuprofen in pediatrics. Int J Clin Pract (Suppl) 2003;(135):9-12.
53. Hamalainen ML, Hoppu K, Valkeila E, Santavuori P. Ibuprofen or acetaminophen for the acute treatment of migraine in children: a double- blind, randomized, placebo-controlled, crossover study. Neurology 1997;48(1):103-7.
54. Treluyer JM, Tonnelier S, d’Athis P, Leclerc B, Jolivet-Landreau I, Pons G. Antipyretic efficacy of an initial 30-mg/kg loading dose of acetaminophen versus a 15-mg/kg maintenance dose. Pediatrics 2001;108(4):E73.
55. Calvani M, Pizzoli M. La gestione della febbre nel bambino: istruzioni per l’uso. Area Pediatrica 2004(5):III-XVI.
56. Mayoral CE, Marino RV, Rosenfeld W, Greensher J. Alternating antipyretics: is this an alternative? Pediatrics 2000;105:1009-12.
57. Scolnik D, Kozer E, Jacobson S, Diamond S, Young NL. Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children. Pediatrics 2002;110(3):553-6.
58. American Accademy of Pediatrics. Acetominophen toxicity in children. Pediatrics 2001; 108:1020-4.
59. Williams DG, Hatch DG, Howard RF. Codeine phosphate in pediatric medicine. Br J Anaesth 2001;86(3):413-21.
60. Moore A, Collins S, Carroll D, McQuay H, Edwards J. Single dose paracetamol (acetaminophen), with and without codeine, for postoperative pain. Cochrane Database Syst Rev 2000(2):CD001547.
61. McQuay H, Moore A. Acute pain: imtroduction. In: McQuay H, Moore A (eds). An Evidence-based resource for pain relief. Oxford: Oxford University Press 1998;53-7.
62. Cunliffe M. Codeine phosphate in children: time for re-evaluation? Br J Anaesth 2001;86(3):329-31.
63. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113(5):1451-65.
2. Meremikwu M, Oyo-Ita A. Paracetamol for treating fever in children. Cochrane Database Syst Rev 2002(2):CD003676.
3. Meremikwu M, Oyo-Ita A. Physical methods for treating fever in children. Cochrane Database Syst Rev 2003(2):CD004264.
4. Schnaidermann D, Lahat E, Sheefer T, Adjalem M. Antipyretic effectiveness of acetaminophen in febrile seizures: ongoing prophylaxis versus sporadic usage. Eur J Pediatr 1993;152:747-9.
5. Uhari M, Rantala H, Vainionpää L, Kurttila R. Effect of acetaminophen and of low intermittent doses of diazepam on prevention of recurrences of febrile seizures. J Pediatr 1995; 126: 991-5.
6. van Stuijvenberg M, Derksen-Lubsen G, Steyerberg EW, Habbema JD, Moll HA. Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences. Pediatrics 1998;102 (5):e51.
7. El-Radhi AS, Barry W. Do antipyretics prevent febrile convulsions? Arch Dis Child 2003; 88(7):641-2.
8. Waruiru C, Appleton R. Febrile seizures: an update. Arch Dis Child 2004;89(8):751-6.
9. Pantell RH, Newman TB, Bernzweig J, et al. Management and outcomes of care of fever in early infancy. JAMA 2004;291(10):1203-12.
10. Tanne JH. Children are often undertreated for pain. BMJ 2003;327:1185.
11. Kharasch S, Saxe G, Zuckerman B. Pain treatment: opportunities an challenges. Arch Pediatr Adolesc Med 2003;157:1054-6.
12. Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med 2002;347(14):1094-103.
13. Cazzato T, Pandolfini C, Campi R, Bonati M, e il Gruppo di lavoro dell’ACP Puglia-Basilicata. Attitudini prescrittive nella pediatria di famiglia. Giorn Ital Farm Clin 2001;15:21-5.
14. Rossi E, De Rosa M, Bonati M, et al. La prescrizione farmaceutica pediatrica nell’ambito delle cure primarie. Rapporto della banca dati ARNO. Giorn Ital Farm Clin 2001;15:26-9.
15. Motola D, Vaccheri A, Silvani MC, Poluzzi E, Bottoni A, De Ponti F, Montanaro N. Pattern of NSAID use in the Italian general population: a questionnaire-based survey. Eur J Clin Pharmacol 2004;60(10):731-8.
16. Giusti MP, Marchetti F, Tognoni G, Bonati M. Uso dei FANS in pediatria. Trattamento della febbre e delle infezioni respiratorie acute: una revisione della letteratura. Medico e Bambino 1995;14(6):285-91.
17. Grazi L, Peccarisi C, Bussone G. La cefalea del bambino e dell’adolescente. Medico e Bambino 2003;22(7): 28-31.
18. Addis A, Bonati M. Use of nimesulide in children. Lancet 1999;354:1034.
19. Ministero della Salute. Guida all’uso dei farmaci per i bambini. 1° edizione. Roma, 2003.
20. Russell FM, Shann F, Curtis N, Mullholland K. Evidence on the use of paracetamol in febrile children. Bullettin of the World Health Organization 2003;81:367-72.
21. Wahba H. The antipyretic effect of ibuprofen and acetaminophen in children. Pharmacotherapy 2004;24(2):280-4.
22. Clavenna A, Bonati M. Una “Dear Doctor Letter” per razionalizzare l’uso dei farmaci antiinfiammatori non steroidei (FANS) nei bambini? Giorn Ital Farm Clin 2001;15:36-7.
23. Belay ED, Breese JS, Holman RC, et al. Reye’s syndrome in the United States from 1981 through 1997. N Engl J Med 1999;340: 1377-82.
24. Menniti-Ippolito F, Sagliocca L, Da Cas R, et al. Niflumic acid and cutaneous reactions in children. Arch Dis Child 2001;84(5):430-1.
25. Lesko SM, Mitchell AA. An assessment of the safety of pediatric ibuprofen. JAMA 1995; 273:929-33.
26. Lesko SM, Mitchell AA. The safety of acetaminophen and ibuprofen among children younger than two years old. Pediatrics 1999; 104:39-44.
27. Lesko SM, Louik C, Vezina RM, Mitchell AA. Asthma morbidity after the short-tem use of ibuprofen in children. Pediatrics 2002;109: 1-4.
28. Nimesulide: controindicata al di sotto dei 12 anni. Bollettino d’informazione sui farmaci 1999;3-4:42-3.
29. Traversa G, Bianchi C, Da Cas R, Abraha I, Minneti-Ippolito F, Venegoni M. Cohort study of hepatotoxicity associated with nimesulide and other non-steroidal anti-inflammatory drugs. BMJ 2003;327:18-22.
30. Carvajal A, Macia MA, Garcia del Pozo J. Small risk ratios may have strong public health impact. BMJ 2003;327:1050-1.
31. Heubi JE, Barbacci MB, Zimmerman HJ. Therapeutic misadventures with acetaminophen: hepatotoxicity after multiple doses in children. J Pediatr 1998;132(1):22-7.
32. Bromer MQ, Black M. Acetaminophen hepatotoxicity. Clin Liver Dis 2003;7(2): 351-67.
33. Riordan M, Rylance G, Berry K. Poisoning in children 2: painkillers. Arch Dis Child 2002; 87(5):397-9.
34. Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 1999; 340(24):1888-99.
35. Hermaszewski R, Hayllar J, Woo P. Gastroduodenal damage due to non-steroidal anti-inflammatory drugs in children. Br J Rheumatol 1993;32(1):69-72.
36. Mulberg AE, Linz C, Bern E, Tucker L, Verhave M, Grand RJ. Identification of nonsteroidal antiinflammatory drug-induced gastroduodenal injury in children with juvenile rheumatoid arthritis. J Pediatr 1993;122(4): 647-9.
37. Lewis SC, Langman MJ, Laporte JR, Matthews JN, Rawlins MD, Wiholm BE. Doseresponse relationships between individual nonaspirin nonsteroidal anti-inflammatory drugs (NANSAIDs) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data. Br J Clin Pharmacol 2002;54 (3):320-6.
38. Aronoff DM, Bloch KC. Assessing the relationship between the use of nonsteroidal antiinflammatory drugs and necrotizing fasciitis caused by group A Streptococcus. Medicine (Baltimore) 2003;82(4):225-35.
39. Lesko SM, O’Brien KL, Schwartz B, Vezina R, Mitchell AA. Invasive group A streptococcal infection and nonsteroidal antiinflammatory drug use among children with primary varicella. Pediatrics 2001;107(5):1108-15.
40. Szer IS, Goldenstein-Schainberg C, Kurtin PS. Paucity of renal complications associated with nonsteroidal antiinflammatory drugs in children with chronic arthritis. J Pediatr 1991; 119(5):815-7.
41. Cuzzolin L, Dal Cere M, Fanos V. NSAIDinduced nephrotoxicity from the fetus to the child. Drug Saf 2001;24(1):9-18.
42. Ulinski T, Guigonis V, Dunan O, Bensman A. Acute renal failure after treatment with nonsteroidal anti-inflammatory drugs. Eur J Pediatr 2004;163(3):148-50.
43. Moghal NE, Hegde S, Eastham KM. Ibuprofen and acute renal failure in a toddler. Arch Dis Child 2004;89:276-7.
44. Lantz B, Cochat P, Bouchet JL, Fischbach M. Short-term niflumic-acid-induced acute renal failure in children. Nephrol Dial Transplant 1994;9(9):1234-9.
45. AA.VV. Risks of agranulocytosis and aplastic anemia. A first report of their relation to drug use with special reference to analgesics. The International Agranulocytosis and Aplastic Anemia Study. JAMA 1986;256(13):1749-57.
46. Desikan SR, Meena NG. Do non-steroidal anti-inflammatory drugs increase the risk of bleeding after tonsillectomy? Arch Dis Child 2004;89(5):493-4.
47. Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004;328:434.
48. Perrot DA, Piira T, Goodenoguh B, Champion D. Efficacy and safety of acetaminophen vs ibuprofen for treating children’s pain and fever. Arch Pediatr Adolesc Med 2004;158: 521-6.
49. Cummings P. Meta-analysis based on standardized effects is unreliable. Arch Pediatr Adolesc Med 2004;158(6):595-7.
50. Autret E, Breart G, Jonville AP, Courcier S, Lassale C, Goehrs JM. Comparative efficacy and tolerance of ibuprofen syrup and acetaminophen syrup in children with pyrexia associated with infectious diseases and treated with antibiotics. Eur J Clin Pharmacol. 1994; 46(3):197-201.
51. Marchetti F. Ibuprofene in pediatria. Medico e Bambino 2001;20(6):387-91.
52. Autret-Leca E. A general overview of the use of ibuprofen in pediatrics. Int J Clin Pract (Suppl) 2003;(135):9-12.
53. Hamalainen ML, Hoppu K, Valkeila E, Santavuori P. Ibuprofen or acetaminophen for the acute treatment of migraine in children: a double- blind, randomized, placebo-controlled, crossover study. Neurology 1997;48(1):103-7.
54. Treluyer JM, Tonnelier S, d’Athis P, Leclerc B, Jolivet-Landreau I, Pons G. Antipyretic efficacy of an initial 30-mg/kg loading dose of acetaminophen versus a 15-mg/kg maintenance dose. Pediatrics 2001;108(4):E73.
55. Calvani M, Pizzoli M. La gestione della febbre nel bambino: istruzioni per l’uso. Area Pediatrica 2004(5):III-XVI.
56. Mayoral CE, Marino RV, Rosenfeld W, Greensher J. Alternating antipyretics: is this an alternative? Pediatrics 2000;105:1009-12.
57. Scolnik D, Kozer E, Jacobson S, Diamond S, Young NL. Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children. Pediatrics 2002;110(3):553-6.
58. American Accademy of Pediatrics. Acetominophen toxicity in children. Pediatrics 2001; 108:1020-4.
59. Williams DG, Hatch DG, Howard RF. Codeine phosphate in pediatric medicine. Br J Anaesth 2001;86(3):413-21.
60. Moore A, Collins S, Carroll D, McQuay H, Edwards J. Single dose paracetamol (acetaminophen), with and without codeine, for postoperative pain. Cochrane Database Syst Rev 2000(2):CD001547.
61. McQuay H, Moore A. Acute pain: imtroduction. In: McQuay H, Moore A (eds). An Evidence-based resource for pain relief. Oxford: Oxford University Press 1998;53-7.
62. Cunliffe M. Codeine phosphate in children: time for re-evaluation? Br J Anaesth 2001;86(3):329-31.
63. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113(5):1451-65.