Paracetamol (Acetaminophen) Syrup Dosing for Pediatric Fever
For pediatric fever management, administer paracetamol syrup at 15 mg/kg per dose every 4-6 hours, not exceeding 5 doses in 24 hours (maximum 75 mg/kg/day). 1
Weight-Based Dosing Algorithm
The dose must be calculated based on the child's weight, not age, to ensure therapeutic efficacy and safety 1, 2:
- Standard dose: 15 mg/kg per dose 1, 2
- Dosing interval: Every 4-6 hours 1, 3
- Maximum frequency: Not more than 5 doses in 24 hours 1
- Daily maximum: Do not exceed 75 mg/kg/day (or 60-75 mg/kg/day depending on regional guidelines) 4, 2
Clinical Rationale
Higher doses (15 mg/kg) are significantly more effective than older subtherapeutic doses (≤10 mg/kg) and demonstrate equivalent efficacy to NSAIDs while maintaining superior safety. 2 Recent evidence shows that 15 mg/kg dosing provides optimal antipyretic and analgesic effects with a tolerability profile similar to placebo 2.
The American Academy of Pediatrics endorses acetaminophen as first-line antipyretic therapy due to its relative safety and effectiveness 1. When compared to ibuprofen, paracetamol at 15 mg/kg demonstrates comparable fever reduction with lower risk of adverse events during repetitive dosing over consecutive days 2.
Administration Guidelines
- Route: Oral administration is preferred when possible 5
- Food: May be given with or without food, though food may improve gastrointestinal tolerance 6, 4
- Concentration: Use standardized 160 mg/5 mL concentration for accurate dosing 1
Critical Safety Considerations
Hepatotoxicity risk occurs with single ingestions exceeding 150 mg/kg or chronic exposures greater than 140 mg/kg/day for several days. 6, 4 Parents must be counseled to:
- Track all doses carefully to avoid accidental overdosing 7
- Check for acetaminophen in other medications (many combination products contain it) 1
- Never exceed the maximum daily dose 1, 4
Treatment Goals and Monitoring
The primary objective is improving the child's comfort, not merely reducing temperature. 1, 6 Important caveats include:
- Antipyretics do not prevent febrile seizures or reduce their recurrence risk 1
- Clinical improvement should occur within 48-72 hours; if not, further investigation is warranted 8, 6
- Adequate fluid intake must be encouraged to prevent dehydration 6, 5
When to Use Alternative Routes
Rectal suppositories should be reserved for situations where oral administration is impossible 6:
- Persistent vomiting
- Severe oral mucositis
- Refusal to take medication orally
- Inability to reliably swallow
Contraindications and Special Populations
Avoid aspirin in children under 16-18 years due to Reye's syndrome risk. 1, 9 Exercise caution with paracetamol in:
- Chronic liver disease or hepatic dysfunction 1
- Severe malnutrition 5
- Newborns (require dose adjustment for gestational age and should be hospitalized for fever evaluation) 5
Combination Therapy
Alternating or combining paracetamol with ibuprofen is discouraged due to increased risk of dosing errors and lack of evidence for superior benefit. 1, 5 If a single agent fails to provide adequate comfort, consider switching to ibuprofen (10 mg/kg every 6-8 hours) rather than combining medications 6, 7.