Antipyretics and Febrile Seizure Recurrence

August 4, 2020

Emergency physicians may often have to answer questions about whether antipyretics can help prevent recurrence of febrile seizures. An examination of studies from recent years provides nuanced answers. Are you familiar with this literature?

Review “What Do Studies Say About Antipyretics and Febrile Seizure Recurrence?” in ACEP Now before you answer the question.

Regarding the current literature on antipyretics and febrile seizure recurrence in children, which of the following is FALSE?

In children who had previously experienced a febrile seizure, a 1998 study found that low dose ibuprofen (5mg/kg) given at fever onset (and until fever free for 24 hours) did not significantly reduce the risk of febrile seizure recurrence over a two-year period.

A 2018 prospective study out of Japan suggests that rectal acetaminophen (10mg/kg) may be effective in reducing the recurrence of febrile seizures over the course of a single illness in a high incidence population.

A 2009 study looked at response to antipyretics in children with previous febrile seizure history over a two-year period. When children were given rectal diclofenac (1.5 mg/kg) at presentation followed by standard doses of acetaminophen (15mg/kg) or ibuprofen (10 mg/kg) for the duration of subsequent fevers, it reduced the risk of febrile seizure recurrence.

A 2017 Cochrane review concluded that antipyretics given for future febrile illnesses do not appear to lower the risk of recurrence of febrile seizures (as assessed over a two-year period).

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