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Febrile seizure management and effectiveness of prevention with antipyretics

02 January 2024
Volume 16 · Issue 1



Before reaching the age of 5, 2–5% of children will have had a febrile seizure. Most are categorised as simple but they can be complex and carry the risk of complications. They can be frightening for parents. UK guidelines advise against the use of antipyretic drugs to prevent febrile seizure recurrence while being mindful of parental sensitivities.


This systematised literature review aimed to appraise the global body of evidence in relation to current guidelines on using conventional antipyretics for the prevention of febrile seizures and explore factors that influence their management.


A research question was developed using the PICO (population/participant(s); intervention(s); comparison/control; outcome) framework and two databases were searched for primary research, and abstracts were screened for relevance.


Thirty-four articles were identified, or which three were relevant to the research aim. These were critically appraised using the Mixed Methods Appraisal Tool and five themes were identified.


One study found that paracetamol may prevent recurrent febrile seizures, one found a small reduction in febrile seizure recurrence when treated with an antipyretic and one found antipyretics ineffective at reducing febrile seizure recurrence. Similar contemporary studies conducted in the UK population may help to improve understanding of the factors influencing febrile seizure management and the effectiveness of antipyretics.

Fever is a common childhood complaint with 20–40% of parents and carers reporting an episode each year (National Institute for Health and Care Excellence (NICE), 2021). The most common cause of fever is infection (El-Radhi et al, 2009). Febrile seizures (FS) occur in 2–5% of healthy preschool children and recur in approximately 40% of these patients (Whelan et al, 2017; National Institute of Neurological Disorders and Stroke, 2023). Using Whelan et al's (2017) statistics, it can be extrapolated that 76 000–190 000 children may experience a FS in their first 5 years.

Children who have complex FS—defined as such if they last longer than 15 minutes, recur within 24 hours or have associated focal neurology—may carry an increased likelihood of mortality in the subsequent two years and those affected are 3.6–5.6% more likely to develop epilepsy, a cause of mortality for 40–80 children per year (Smith et al, 2019; Royal College of Paediatrics and Child Health, 2013).

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