From the Guidelines
Ibuprofen is the preferred antipyretic for a patient spiking a fever every 3 hours, as it is superior to paracetamol for reducing fever. According to the study published in the BMJ in 2005 1, ibuprofen is the recommended choice for treating hyperpyrexia, which increases the risk of convulsions in children. The dose of ibuprofen should be reduced in cases complicated by impaired renal function. Some key points to consider when administering ibuprofen include:
- Reducing the dose in cases of impaired renal function
- Monitoring for potential side effects, such as gastrointestinal and renal issues
- Ensuring the patient's blood glucose levels are stable, as hypoglycaemia can be a complication, especially in severe cases It's essential to note that while the study focuses on the management of severe malaria in children, the principle of using ibuprofen as an antipyretic can be applied to other cases of recurrent fever, prioritizing the patient's morbidity, mortality, and quality of life.
From the FDA Drug Label
Directions do not take more than directed (see overdose warning) adults and children 12 years and over take 2 caplets every 6 hours while symptoms last do not take more than 6 caplets in 24 hours, unless directed by a doctor The FDA drug label does not answer the question.
From the Research
Antipyretic Options for Recurrent Fever
To manage a patient with recurrent fever (pyrexia) every 3 hours, several antipyretic options can be considered:
- Paracetamol (acetaminophen) is a commonly used antipyretic, which works by inhibiting cyclooxygenase-3 and prostaglandin synthesis in the central nervous system, resetting the hypothalamic heat-regulation center 2.
- High-dose paracetamol (20 mg/kg) has been shown to have a similar antipyretic effect to mefenamic acid, with a faster onset of action and longer duration of action 3.
- Acetaminophen has also been found to be safe and effective in preventing febrile seizure recurrences during the same fever episode 4.
- Ibuprofen is another option, which has been compared to acetaminophen in several studies, showing equivalent fever reduction and tolerability in febrile children 5, 6.
- An alternating regimen of acetaminophen and ibuprofen every 4 hours has been found to be more effective than monotherapy in lowering fever in infants and children 6.
Dosage and Administration
The dosage and administration of these antipyretics vary:
- Paracetamol: 15-20 mg/kg every 4-6 hours 2, 3.
- Ibuprofen: 5-10 mg/kg every 6-8 hours 5, 6.
- Acetaminophen: 12.5-15 mg/kg every 4-6 hours 4, 6.
- Mefenamic acid: 6 mg/kg every 4-6 hours 3.
Considerations
When choosing an antipyretic, it is essential to consider the patient's age, weight, and medical history, as well as the potential risks and benefits of each medication 2, 3, 4, 5, 6.