E-Journal Club april 2019

Feberkramper ser voldsomme ud, så forældre efterspørger metoder til at undgå recidiv. Hvordan kan du så rådgive i forhold til antipyretisk behandling?
Bliv klogere i denne 10 år gamle artikel fra Finland om et dobbeltblindet RCT, hvor både paracetamol og NSAID bliver testet sammen og hver for sig.

 

Artikel:

Antipyretic agents for preventing recurrences of febrile seizures: randomized controlled trial 

Strengell T et al.

Arch Pediatr Adolesc Med

 

OBJECTIVE:
To evaluate the efficacy of different antipyretic agents and their highest recommended doses for preventing febrile seizures.

DESIGN:
Randomized, placebo-controlled, double-blind trial.

SETTING:
Five hospitals, each working as the only pediatric hospital in its region.

PARTICIPANTS:
A total of 231 children who experienced their first febrile seizure between January 1, 1997, and December 31, 2003. The children were observed for 2 years.

INTERVENTIONS:
All febrile episodes during follow-up were treated first with either rectal diclofenac or placebo. After 8 hours, treatment was continued with oral ibuprofen, acetaminophen, or placebo.

MAIN OUTCOME MEASURE:
Recurrence of febrile seizures.

RESULTS:
The children experienced 851 febrile episodes, and 89 of these included a febrile seizure. Febrile seizure recurrences occurred in 54 of the 231 children (23.4%). There were no significant differences between the groups in the main measure of effect, and the effect estimates were similar, as the rate was 23.4% (46 of 197) in those receiving antipyretic agents and 23.5% (8 of 34) in those receiving placebo (difference, 0.2; 95% confidence interval, -12.8 to 17.6; P = .99). Fever was significantly higher during the episodes with seizure than in those without seizure (39.7 degrees C vs 38.9 degrees C; difference, 0.7 degrees C; 95% confidence interval, -0.9 degrees C to -0.6 degrees C; P < .001), and this phenomenon was independent of the medication given.

CONCLUSIONS:
Antipyretic agents are ineffective for the prevention of recurrences of febrile seizures and for the lowering of body temperature in patients with a febrile episode that leads to a recurrent febrile seizure.

TRIAL REGISTRATION:
ClinicalTrials.gov NCT00568217.

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