Oral antipyretic therapy

Abstract

The capacity of benorylate, an ester of acetylsalicylic acid and paracetamol, to reduce fever in children was compared with that of the components as such or as a combination. The series of cases studied consisted of 66 patients between the ages of 4 months and 12 years with rectal temperatures above 38.5 degrees C. Temperatures were recorded at 15 and 20 min and 1, 2, 4 and 6 hrs after the administration of the drug. The antipyretic effect of combined acetylsalicylic acid (11 mg/kg) and paracetamol (14 mg/kg) was superior to the effect of benorylate with a dose of 25 mg/kg and even of 50 mg/kg as well as better than the effect of either drug alone. Acetylsalicylic acid (10 mg/kg) and paracetamol (12.5 mg/kg) alone produced a significantly greater antipyretic effect than benorylate with a dose of 25 mg/kg. Given in a dose of 35--40 mg/kg, benorylate seems to have a significant antipyretic effect. However, this effect is clearly smaller than that of either of its components, acetylsalicylic acid or paracetamol. Therefore benorylate is probably not suitable to be used as a general antipyretic agent in children.

Efficacy of Standard Doses of Ibuprofen Alone, Alternating, and Combined With Acetaminophen for the Treatment of Febrile Children

“…The findings from the last 3 hours of observation confirmed the hypothesis at the study’s outset and are consistent with other studies that tested combinations of acetaminophen and aspirin decades ago. 30,31 Additionally, the data describing greater antipyresis in the treatment group in which ibuprofen and acetaminophen were coadministered are highly relevant to parents who give medication to their children before day care, school, or sleep.…”

Antipyretic Efficacy and Safety of Ibuprofen and Acetaminophen in Children

“…The magnitude of the differences in mean temperatures between the 2 drugs was found to vary over time, with the differences being greatest between 3-8 hours and 16-24 hours after administration. 13 Other studies found no significant difference in the single-dose antipyretic effect of ibuprofen and acetaminophen as measured by change in temperature over time, 10,12,14,20,21 duration of temperature reduction, 12,14 and extent of temperature reduction. 10,12,14 Ibuprofen 10 mg/kg decreased temperature by ≥1˚C in 90% (n = 26) of children aged 5 months to 13 years compared with 79% (n = 23) given acetaminophen 10 mg/kg.…”

“…Several of these studies compared more than one dosage of ibuprofen with acetaminophen. 2,9,13,15,17-20 A variety of outcome measures were used to compare the antipyretic effects of ibuprofen and acetaminophen including AUC of percentage reduction of temperature with respect to time, 2,9,11,15,17 change in temperature over time, 10,12,14,16,19,20 and duration 9,10,12,14,19 and extent of temperature reduction after a single dose of medication. 10,12,14…”

“…While some trials concluded that the proportion of patients who experienced adverse events was not significantly different between treatment groups, 2,16,22 several studies have reported no adverse effects related to antipyretic use. 14,15,20 Other studies have reported adverse effects in 0-26.6% of febrile children treated with ibuprofen compared with 0.9-19% treated with acetaminophen. 2,9,[11][12][13] Patients in the ibuprofen group reported at least one adverse event more than with the use of acetaminophen, 11 with gastrointestinal symptoms and sweating being the most common.…”

Anti-Inflammatory and Anticoagulant Activities of Synthesized NSAID Prodrug Esters

“…Esterase enzymes are responsible for the hydrolysis of prodrugs into their active polar water-soluble forms compared with the parent prodrug ester. A prodrug with an ester linkage can also be used to deliver two active drugs; this technique was used in the synthesis of many prodrugs that have anti-inflammatory, analgesic and antipyretic properties [ 1 ].…”