Tepid sponging plus dipyrone versus dipyrone alone for reducing body temperature in febrile children
Keywords:
Fever, Dipyrone, Child, Baths, AntipyreticsAbstract
CONTEXT AND OBJECTIVE: The role of tepid sponging to promote fever control in children is controversial. We did not fi nd any studies reporting on the effectiveness of tepid sponging in addition to dipyrone. The aim of this study was to compare the effects of tepid sponging plus dipyrone with dipyrone alone for reducing fever. DESIGN AND SETTING: A randomized clinical trial was undertaken at Instituto Materno-Infantil Professor Fernando Figueira, Recife, Pernambuco. METHODS: Children from six months to fi ve years old with axillary temperature greater than 38 nC in the emergency ward between January and July 2006 were eligible. One hundred and twenty children were randomly assigned to receive oral dipyrone (20 mg/kg) or oral dipyrone and tepid sponging for 15 minutes. The primary outcome was mean temperature reduction after 15, 30, 60, 90 and 120 minutes. Secondary outcomes were crying and irritability. RESULTS: 106 children fi nished the study. After the fi rst 15 minutes, the fall in axillary temperature was signifi cantly greater in the sponged group than in the control group (p < 0.001). From 30 to 120 minutes, better fever control was observed in the control group. Crying and irritability were observed respectively in 52% and 36% of the sponged children and in none and only two of the controls. CONCLUSIONS: Tepid sponging plus dipyrone cooled faster during the fi rst 15 minutes, but dipyrone alone presented better fever control over the two-hour period. Tepid sponging caused mild discomfort, crying and irritability for most of the children.
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References
Baucher R. Fever: approach to the febrile child. In: Green- Hernandez C, Singleton JK, Aronzon DZ, editors. Primary care pediatrics. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 343-57.
Betz MG, Grunfeld AF. ‘Fever phobia’ in the emergency de- partment: a survey of children’s caregivers. Eur J Emerg Med. 2006;13(3):129-33.
Prewitt EM. Fever: facts, fiction, physiology. Crit Care Nurse. 2005;Suppl:8-10, 12, 14 passim; quiz 18-9.
Mackowiak PA. Assaulting a physiological response. Clin Infect Dis. 1997;24(6):1214-6.
Purssell E. Physical treatment of fever. Arch Dis Child. 2000;82(3):238-9.
Styrt B, Sugarman B. Antipyresis and fever. Arch Intern Med. 1990;150(8):1589-97.
Mackowiak PA, Plaisance KI. Benefits and risks of antipyretic therapy. Ann N Y Acad Sci. 1998;856:214-23.
Axelrod P. External cooling in the management of fever. Clin Infect Dis. 2000;31(Suppl 5):S224-9.
Meremikwu M, Oyo-Ita A. Physical methods for treating fever in children. Cochrane Database Syst Rev. 2003;(2): CD004264.
Sharber J. The efficacy of tepid sponge bathing to reduce fever in young children. Am J Emerg Med. 1997;15(2):188-92.
Aksoylar S, Aksit S, Ca layan S, Yaprak I, Bakiler R, Cetin F. Evaluation of sponging and antipyretic medication to reduce body temperature in febrile children. Acta Paediatr Jpn. 1997;39(2):215-7.
Mahar AF, Allen SJ, Milligan P, et al. Tepid sponging to reduce temperature in febrile children in a tropical climate. Clin Pediatr (Phila). 1994;33(4):227-31.
Anvisa. Painel Internacional de Avaliação da Segurança da Dipirona. Brasília, 3 e 4 de julho de 2001. Available from: http://www.anvisa.gov.br/divulga/informes/relatoriodipirona2.pdf. Accessed in 2008 (Mar 31).
Arcila-Herrera H, Barragán-Padilla S, Borbolla-Escoboza JR, et al. Consenso de un grupo de expertos mexicanos. Eficacia y seguridad del metamizol (dipirona). [Consensus of a group of Mexican experts: efficacy and safety of metamizol (Dipirone)]. Gac Med Mex. 2004;140(1):99-101.
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.
Agbolosu NB, Cuevas LE, Milligan P, Broadhead RL, Brewster D, Graham SM. Efficacy of tepid sponging versus paracetamol in reducing temperature in febrile children. Ann Trop Paediatr. 1997;17(3):283-8.
Friedman AD, Barton LL. Efficacy of sponging vs acetamino- phen for reduction of fever. Sponging Study Group. Pediatr Emerg Care. 1990;6(1):6-7.
Bernath VF, Anderson JN, Silagy CA. Tepid sponging and paracetamol for reduction of body temperature in febrile children. Med J Aust. 2002;176(3):130.
Greisman LA, Mackowiak PA. Fever: beneficial and detrimental effects of antipyretics. Curr Opin Infect Dis. 2002;15(3):241-5.
Fisher RG, Boyce TG. Fever and shock syndromes. In: Fisher RG, Boyce TG, editors. Moffet’s pediatric infectious diseases: a problem-oriented approach. 4th edition. New York: Lippincott Williams & Williams; 2005. p. 319-73.