Quality use of medicines: The febrile child

Abstract

This article was initially prompted by an exchange on the E-DRUG email list in January 1998 (see http://www.essentialdrugs.org/) about diclofenac and mefenamic acid use in children, for fever with or without pain. A clinician in Trinidad and Tobago noted that these agents were being recommended in his country and was worried about side effects.The response was surprisingly negative: one correspondent (writing from the United States) noted that mefenamic acid use was particularly prevalent in South Africa "despite the unfavourable risk/benefit ratio of mefenamic acid, the availability of safer drugs, and the doubts regarding the use of antipyretics in children with moderate fever".A German correspondent noted that it should not be used in children younger than l4 (which surprise the moderator, who recalled it being "a very popular analgesic for children", presumably when he practised in Zimbabwe). Another, from Pakistan, expressed the view that "it is not clear whether there is any benefit treating fevers lower than 41"C". A response from a United Kingdom drug information centre called both "unusual choices for children", claiming that mefenamic acid cause "convulsions in overdose, even with relatively small amounts". A Dutch physician was surprised "that so many people have simply forgotten why many countries refuse or deleted "Ponstan" 20-30 years ago", citing the risk of haemolytic anaemia. An Italian also noted that neither anti-inflammatory was indicated for antipyretic use.