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Antipyretic prehospital therapy for febrile convulsions: Does the treatment fit? A literature review

Objective The objective of this literature search was to find evidence to support (or refute) the prehospital emergency use of antipyretic therapies, such as tepid sponging and paracetamol, to prevent the recurrence of febrile convulsions. Methods An on-line literature search was made of Medline. The key text words utilised were febrile convulsion(s); febrile seizure(s); infantile convulsion(s); paracetamol; acetaminophen; rectal administration; treatment; prevention; pathophysiology, (a)etiology; recurrence; tepid; sponging; bathing; antipyretic; temperature reduction; fever. References from retrieved papers were also sought and reviewed where available. Each paper was critically appraised for relevance and content. Results Forty-eight papers were identified. Twenty-nine were irrelevant. Conclusions The available evidence suggests that neither antipyretic medication (including paracetamol) nor tepid sponging prevent the recurrence of febrile convulsions following a simple initial fit, and both are associated with risk to the patient. We recommend that neither intervention be used in the prehospital phase of treatment.