FEVER IN CHILDREN

Antipyretic Efficacy and Tolerability of a Single Intravenous Dose of the Acetaminophen Prodrug Propacetamol in Children: A Randomized, Double-Blind, Placebo-Controlled Trial

Philip D. Walson, MD; Jim Jones, PharmD; Russell Chesney, MD; and Alexander Rodarte, MD

Commentary by Jeffrey L. Blumer, PhD, MD
Section Editor, Pediatric Research
Case Western Reserve University
Rainbow Babies and Children's Hospital

Fever is among the most common signs leading pediatric patients and their families to seek physician consultation. In otherwise healthy children, fever is of little consequence other than its accompanying malaise and the attendant behavioral effects that greatly distress parents. For these reasons, antipyretics, particularly acetaminophen, are the medicines most commonly prescribed to infants and children. Oral and rectal formulations are readily available; however, in the United States, parenteral formulations are not. Among critically ill infants and children, fever may pose a clinically important threat. Hyperpyrexia has been associated with increased metabolic demand on the heart, brain, and other vital organs, further exacerbating disease- or trauma-associated dysfunction. In their report "Antipyretic Efficacy and Tolerability of a Single Intravenous Dose of the Acetaminophen Prodrug Propacetamol in Children: A Randomized, Double-Blind, Placebo-Controlled Trial" (Clin Ther. 2006;28:762–769), Walson et al describe the effectiveness and tolerability of a parenteral prodrug formulation of acetaminophen, which may provide a new alternative for the treatment of fever in children who could benefit from fever control but are unable to use or tolerate the existing formulations. Until recently, the only alternatives available for these patients were physical cooling, with its attendant discomforts, and parenteral ketorolac, with its risk for platelet dysfunction and bleeding. Propacetamol and the newer diluted acetaminophen formulation available in Europe for parenteral use represent simple yet effective solutions to an important unmet medical need.

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