Fever in children is one of the most frequent queries in the pharmacy. As healthcare professionals, our responsibility is to ensure correct dispensing and accurate advice on antipyretics such as paracetamol and ibuprofen, avoiding dosing errors that can have serious consequences.
The final decision on treatment and dose must always be supervised by the prescribing doctor. The pharmacist informs, advises, and refers when necessary.
Paracetamol in Paediatrics: Dose and Precautions
Paracetamol is the first-choice antipyretic in children, especially in those under 6 months or at risk of dehydration. Its main mechanism of action is central, reducing fever and pain. It is essential to remember that the dose is calculated based on the child's weight, not their age. The recommended dose is 10-15 mg/kg per dose, with a minimum interval of 4-6 hours between doses and a maximum daily dose of 60 mg/kg.
It is crucial to instruct parents on how to measure the dose correctly, using the dosing syringe that accompanies the medicine. A common error is confusing millilitres with milligrams or using household spoons. We should always ask for the child's exact weight and, if possible, calculate the dose in front of the patient or their guardians. For more information on medicine safety, the Spanish Agency of Medicines and Medical Devices (AEMPS) offers valuable resources. Readers should check with their own national regulator for up-to-date regulatory information.
Ibuprofen in Paediatrics: When and How to Use It
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that acts as an antipyretic, analgesic, and anti-inflammatory. It is recommended as a second option or when an additional anti-inflammatory effect is sought, generally from 3 months of age. The usual dose is 5-10 mg/kg per dose, with an interval of 6-8 hours and a maximum daily dose of 30 mg/kg. It is important to remember that ibuprofen should be administered with food to reduce the risk of gastric irritation.
We must warn about its use in children with dehydration, chickenpox, or asthma, as it can exacerbate these conditions. The Vademecum technical data sheet is an indispensable tool for verifying the indications, contraindications, and specific posology of each commercial presentation. Therapeutic adherence in paediatrics is key, and good pharmaceutical advice can make a difference.
Common Errors and Tips for Safe Dispensing
Medication errors in paediatrics are a constant concern. One of the most frequent is confusion between syrup concentrations (for example, ibuprofen 2% vs 4%). We must always verify the concentration and the child's weight to calculate the correct dose. Another error is the simultaneous administration of several medicines containing the same active ingredient, which can lead to an overdose.
Our role as pharmacists is to educate parents. We can offer them a personalised dosing chart or remind them of the importance of always consulting the paediatrician or pharmacist before administering any medicine. Paediatric pharmacy care is a fundamental pillar for child health.
Health Education and Referral to the Doctor
Beyond dispensing, the pharmacy is a key point for health education. We must explain to parents when it is necessary to see a doctor (persistent high fever, changes in the child's general condition, difficulty breathing, skin rashes, etc.). It is also important to demystify 'fever phobia' and remember that fever is a defence mechanism of the body.
In cases of polypharmacy or chronic diseases, it is essential to review the child's pharmacotherapeutic profile to avoid interactions or duplications. Polypharmacy management is a valuable service in community pharmacy. Whenever we have doubts or detect a risk situation, referral to the doctor is our professional obligation.
Can I alternate paracetamol and ibuprofen in children?
Although it is a widespread practice, current guidelines (such as those from the Spanish Association of Paediatrics) do not recommend systematic alternation. It can lead to dosing confusion and increase the risk of errors. It is preferable to use a single antipyretic and, if it is not effective, switch to the other under medical supervision.
What should I do if the child vomits the antipyretic?
If the child vomits the medicine immediately after taking it, a new dose can be attempted. If a considerable time has passed (more than 15-20 minutes) or we are unsure how much has been absorbed, it is better to wait for the next dosing interval to avoid an overdose. When in doubt, always consult the paediatrician.
Is it safe to use paracetamol suppositories?
Suppositories are a useful option when the child cannot take oral medication (vomiting, refusal). However, their absorption is more erratic and slower than the oral route. The dose is also calculated by weight. It is important to remember that they should not be used routinely and always under guidance.
Do you want to delve deeper into paediatric pharmacology and improve your pharmacy care? Explore our pharmacy clinical calculators for more resources and practical guides.
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