Hirakata City, Japan—Acetaminophen appears to reduce the recurrence of febrile seizures (FS) during the same fever episode for children, according to a new study confirming the drug’s safety in that situation.

The report in Pediatrics adds, however, that the constant use of acetaminophen in children with FS is not recommended because the outcomes of the seizures are usually favorable.

“The most important aspect of clinical practice against FS is providing appropriate explanations to parents to relieve anxiety and to ensure appropriate use of acetaminophen on the basis of the individual conditions,” explain Japanese researchers from Hirakata City Hospital.

The recent study sought to confirm the safety of using acetaminophen for FS and to assess its efficacy in preventing FS recurrence during the same fever episode.

Background information in the article points out that acetaminophen has long been thought to be ineffective for preventing FS recurrence both in the same fever episode and in subsequent episodes. This study is touted as the first randomized, controlled trial to assess the ability of acetaminophen to prevent FS recurrence during the same fever episode.

The report notes that FS are the most common type of seizure in childhood, with a cumulative incidence of 2% to 5%, but remain poorly understood. The study authors describe how, in Japan, some pediatricians still counsel caregivers that antipyretics will increase the risk of FS recurrence. 

“Although FSs are usually benign, they can be frightening for parents and caregivers,” researchers write. “Therefore, understanding the relationship between antipyretics and FSs is critical for ensuring proper treatment.”

Their single-center, prospective, open, randomized, controlled study included children and infants (age range: 6-60 months) with FS who visited Hirakata City Hospital between May 1, 2015, and April 30, 2017.

Researchers gauged the effectiveness of acetaminophen by comparing the recurrence rates of patients in whom rectal acetaminophen (10 mg/kg) was administered every 6 hours until 24 hours after the first convulsion, if the fever remained lower than 38.0°C, to the rates of patients in whom no antipyretics were administered.

The trial, which used no placebo, defined the primary outcome as FS recurrence during the same fever episode.

Results indicate that the FS recurrence rate was significantly lower in the rectal acetaminophen group (9.1%) than in the no antipyretics group (23.5%; P <.001). The study team emphasizes that, among the variables in the final multiple logistic regression analysis, rectal acetaminophen use was the largest contributor to the prevention of FS recurrence during the same fever episode (odds ratio: 5.6; 95% confidence interval: 2.3-13.3).

“Acetaminophen is a safe antipyretic against FSs and has the potential to prevent FS recurrence during the same fever episode,” the authors concluded.

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