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Paracetamol and febrile convulsions

Sometimes a study appears that makes you think: ‘why on earth has no-one done this before?’ Febrile convulsions (FCs) are one of the most common emergencies we see, and for many years we have been recommending antipyretics, specifically paracetamol (acetaminophen). Conventional teaching has it that paracetamol might make the child feel better but won’t actually reduce the risk of a further seizure. This is based on trials using paracetamol in febrile children who have not yet had a fit. A study from Japan claims to be the first randomised trial of paracetamol given after the first FC, rather than prophylactically, and it seems to work (Murata S et al doi:10.1542/peds.2018–1009).

In a single-centre unblinded trial, they randomised 420 children aged 6 months to 5 years who presented to their emergency department with a FC lasting less than 15 min. Fever was defined as ≥38.0°C. Those with underlying neurological or metabolic conditions, who had ever been given rectal diazepam, or had co-incidental diarrhoea, were excluded. Cases were given rectal paracetamol 10 mg/kg, repeated six hourly while fever lasted, and controls nothing: there was no placebo. The cases had significantly fewer recurrent FCs within 24 hours (9.1% vs 23.5% in …

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