After a first febrile seizure, antipyretic control during the initial febrile illness is recommended with the hope of preventing a recurrence. How strong is the evidence for the use of antipyretic therapy to prevent a febrile seizure recurrence? Murata et al. (10.1542/peds.2018-1009) have come forward with a study we are early releasing that tried to address the role of acetaminophen on recurrent seizures during an episode of fever. The authors report on the results of a prospective, open randomized controlled study at a single site involving 423 patients ages 6-60 months with a febrile seizure. Rectal acetaminophen was given every 6 hours to one group of randomized patients (n=219) at a dose of 10mg/kg as long as the fever stayed above 38.0 C and no antipyretics were given to the other (control) group of patients (n=204) rather than a placebo. The outcome was whether or not a recurrent febrile seizure ensued.
The results did show a difference with only 9.1% of children in the acetaminophen group versus 23.5% of the children having a recurrent febrile seizure. The antipyretic made a difference even when the results were adjusted for possible confounders. This study, though relatively simple in its methods, provides solid evidence for supporting what most pediatricians recommend—although until now perhaps without the data to back up the recommendation. Hopefully you are recommending good antipyresis following a febrile seizure for the rest of the febrile episode, but if not, this study should have you doing so at a feverish pace going forward.