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Letters to the Editor

Indian Pediatrics 2002; 39:1074

Antipyretic Effect of Nimesulide and Paracetamol in Children


We read the recent article(1) on this subject and have following comments to offer:

1. As per Table I, the number of cases requiring specific therapy is more in nimesulide group which may be contributing to better response with nimesulide except in pneumonia. On the other hand, number of cases of unspecified fever is less in nimesulide group further authenticating the better results with nimesulide as compared to paracetamol. Nimesulide is a potent anti-inflammatory agent in contrast to poor anti-inflammatory activity of paracetamol(2).

2. The primary outcome variable i.e., the mean hours to reach normal temperature is 13.4 with paracetamol. The number of fever cycles in the illness episode i.e., secondary outcome variable is 2.9 with paracetamol. So to get the early response and to decrease the fever cycles, the frequency of administration has to be increased. The paracetamol is normally recommended 4-6 hourly(3). Adminis-tering paracetamol 8 hourly will definitely decrease antipyretic effect and hence decreased efficacy.

3. The mean temperature at enrollment in nimesulide group is 38.3º C and mean decrease in temperature is 1.6ºC. So the mean temperature achieved at end is 36.7ºC. Similarly in paracetamol group, mean temperature at enrollment is 38.1ºC and mean decrease is 1.4ºC giving mean temperature of 36.7ºC at end. But the mean temperature shown in Fig. 1 in results does not fall below 37º C.

4. The reasons for excluding cases having temperature more than 40º C have not been given.

5. The nature and type of rescue therapy given in 2 cases in each group not responding to antipyretics has not been mentioned.

6. No doubt the trial was double blinded but the possibility of study being biased cannot be ruled out as one of the authors (DS) is an employee of Ms. Panacea Biotec, a pharmaceutical company that manufactures nimesulide (Nimulid) used and provided financial assistance for the study.

K.K. Locham,

Manpreet Sodhi,

Geetanjali Jindal,

Department of Pediatrics,

Government Medical College,

Rajindra Hospital,

Patiala 147 001, India.

.

 

References


1. Kapoor SK, Sharma J, Batra B, Paul E, Anand K, Sharma D. Comparison of antipyretic effect of nimesulide and paracetamol in children attending a secondary level hospital. Indian Pediatr 2002; 39: 473-477.

2. Roberts LJ, Morrow JD. Analgesic-antipyretic and anti-inflammation agents and drugs employed in the treatment of gout. In: Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th edn. Eds. Joel G Hardman, Lee E Limbird, Alfred Goodman Gilman. New York, McGraw Hill, Medical Publishing Division 2001; pp 687-731.

3. Gal P, Reed MD. Medications. In: Nelson Textbook of Pediatrics. 16th edn. Eds Behrman RE, Kliegman RM, Jenson HB. Philadelphia, W.B. Saunders Company 2000; pp 2235-2304.

 

 

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