Effectiveness of Oral vs Rectal Acetaminophen

Abstract

Rectal and oral acetaminophen are comparable with respect to temperature reduction. The American Academy of Pediatrics recommendation to refrain from rectal acetaminophen in children should possibly be revised.

Should We Really Encourage Fan Use?

“…1 Our meta-analysis showed that pharmacodynamic variables, such as temperature reduction, were similar with rectal and oral administration. The American Academy of Pediatrics' recommendation to refrain from rectal acetaminophen was based on pharmacokinetic studies showing great variation of peak levels of acetaminophen administered rectally, often not achieving therapeutic levels, with longer time to peak concentrations.…”

“…1 We agree that bias is a threat to validity in any epidemiological study and must be rigorously assessed when interpreting findings. 1 We agree that bias is a threat to validity in any epidemiological study and must be rigorously assessed when interpreting findings.…”

Acetaminophen in Children: Which Dosage, Which Route?

“…Because of reduced efficacy due to poor absorption and the risk of cumulative toxicity due to high or frequent doses, even American Academy of Paediatrics (AAP) has recommended that suppository be used only for oral intolerance cases like as vomiting [7][8][9]. In a meta-analysis, published by Goldstein et al [10] in 2008, it was found that there was no difference in oral and rectal acetaminophen antipyretic effects [8][9][10].…”

“…In a study by Leary et al on 38 children aged 2 to 54 months, it was found that oral acetaminophen (60 mg for children under one year of age and 120 mg for children older than one year) was more effective than rectal enema with a similar dose in controlling children's fever. They recommended that acetaminophen be administered orally to control fever in children [9][10][11]. Scolnik et al [9] showed no significant difference between the temperatures decrement (the maximum drop in temperature or final temperature or in temperature change during the 3 hours after administration) in children 6 months to 6 years of age treated with 15 mg/kg oral acetaminophen and the same or double dose rectally [7][8][9].…”

“…Similarly, in a study by Vernon et al on 37 children aged 3 months to 6 years, no difference in antipyretic effects of oral and rectal acetaminophen at a dose of 15 mg/kg was observed. They concluded that rectal acetaminophen is an acceptable alternative to control fever in children who cannot take it orally [10][11][12]. In a study by Nabulsi et al [7] on 51 children with fever no significant differences were found among the three groups (15 mg/kg orally, 15 mg/kg rectally, or 35 mg/kg rectally) in the time to maximum antipyresis, time to fever reduction by 1ºC or the mean hourly temperature from baseline to 6 hours following dose administration.…”