Comparison of High Loading Dose Versus Usual Dose of Rectal Acetaminophen in the Treatment of Febrile Children

The superiority of antipyretic efficacy of high dose rectal acetaminophen is not well established yet. The present study aimed to compare the antipyretic effectiveness of high loading dose (30 mg/kg) and standard dose (15mg/kg) of rectal acetaminophen in febrile children. This triple blind randomized clinical trial was conducted on 76 patients aged 6 months to 6 years with rectal temperature of > 39˚ C who had been referred to 17th Shahrivar training hospital of Rasht, Guilan, Iran. The patients were assigned to one of two groups: First group (n = 37 patients) received 15 mg/kg and the second group (n = 39 patients) received 30 mg/kg of acetaminophen rectally. The patient’s rectal temperatures were measured before rectal acetaminophen administration and one and three hours post administration using Microlife rectal digital thermometer (Sweden) and were compared between the two groups. One hour after rectal administration of acetaminophen the mean temperature changes in groups 1 and 2 were 0.97 ± 0.59˚C and 1.03 ± 0.62˚C, respectively (P value = 0.663). A significant difference was seen in the mean temperature reduction between the two groups three hour after treatment (1.22 ± 0.72˚C vs. 1.57 ± 0.65˚C, respectively; P value = 0.028). In febrile children, administration of 30 mg/kg of rectal acetaminophen as the loading dose may be more effective than the standard dose in reducing fever after 3 hours of medication.