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.
