Editing Paracetamol (section)

===Fever===
Paracetamol is used for reducing fever.<ref name=":2" /> However, there has been a lack of research on its [[antipyretic]] properties, particularly in adults, and thus its benefits are unclear.<ref name="pmid19058473" /> As a result, it has been described as [[Overmedication|over-prescribed]] for this application.<ref name="pmid19058473">{{cite journal |vauthors=Warwick C |title=Paracetamol and fever management |journal=J R Soc Promot Health |volume=128 |issue=6 |pages=320–323 |date=November 2008 |pmid=19058473 |s2cid=25702228 |doi=10.1177/1466424008092794}}</ref> In addition, low-quality [[Randomized clinical trial|clinical data]] indicates that when used for the [[common cold]], paracetamol may relieve a [[nasal congestion|stuffed]] or [[rhinorrhea|runny]] nose, but not other cold symptoms such as [[sore throat]], [[malaise]], [[sneezing]], or [[cough]].<ref name="pmid23818046">{{cite journal |vauthors=Li S, Yue J, Dong BR, Yang M, Lin X, Wu T |title=Acetaminophen (paracetamol) for the common cold in adults |journal=Cochrane Database Syst Rev |volume=2013 |issue=7 |pages=CD008800 |date=July 2013 |pmid=23818046 |pmc=7389565 |doi=10.1002/14651858.CD008800.pub2}}</ref>

For people in [[Critical care medicine|critical care]], paracetamol decreases body temperature by only 0.2{{ndash}}0.3{{nbsp}}°C more than control interventions and has no effect on their [[Mortality rate|mortality]].<ref name="pmid27992852">{{cite journal |vauthors=Chiumello D, Gotti M, Vergani G |title=Paracetamol in fever in critically ill patients-an update |journal=J Crit Care |volume=38 |issue= |pages=245–252 |date=April 2017 |pmid=27992852 |doi=10.1016/j.jcrc.2016.10.021 |s2cid=5815020}}</ref> It did not change the outcome in febrile patients with stroke.<ref name="pmid28289240">{{cite journal |vauthors=de Ridder IR, den Hertog HM, van Gemert HM, Schreuder AH, Ruitenberg A, Maasland EL, Saxena R, van Tuijl JH, Jansen BP, Van den Berg-Vos RM, Vermeij F, Koudstaal PJ, Kappelle LJ, Algra A, van der Worp HB, Dippel DW |title=PAIS 2 (Paracetamol [Acetaminophen] in Stroke 2): Results of a Randomized, Double-Blind Placebo-Controlled Clinical Trial |journal=Stroke |volume=48 |issue=4 |pages=977–982 |date=April 2017 |pmid=28289240 |doi= 10.1161/STROKEAHA.116.015957 |doi-access=free |title-link = doi }}</ref> The results are contradictory for paracetamol use in sepsis: higher mortality, lower mortality, and no change in mortality were all reported.<ref name="pmid27992852"/> Paracetamol offered no benefit in the treatment of [[dengue fever]] and was accompanied by a higher rate of liver enzyme elevation: a sign of potential liver damage.<ref name="pmid31000122">{{cite journal |vauthors=Deen J, von Seidlein L |title=Paracetamol for dengue fever: no benefit and potential harm? |journal=Lancet Glob Health |volume=7 |issue=5 |pages=e552–e553 |date=May 2019 |pmid=31000122 |doi=10.1016/S2214-109X(19)30157-3 |doi-access=free |title-link = doi }}</ref> Overall, there is no support for a routine administration of antipyretic drugs, including paracetamol, to hospitalized patients with fever and infection.<ref name="pmid31116598">{{cite journal |vauthors=Ludwig J, McWhinnie H |title=Antipyretic drugs in patients with fever and infection: literature review |journal=Br J Nurs |volume=28 |issue=10 |pages=610–618 |date=May 2019 |pmid=31116598 |doi=10.12968/bjon.2019.28.10.610 |s2cid=162182092}}</ref>

The efficacy of paracetamol in children with fever is unclear.<ref>{{cite journal |vauthors=Meremikwu M, Oyo-Ita A |title=Paracetamol for treating fever in children |journal=Cochrane Database Syst Rev |issue=2 |page=CD003676 |year=2002 |volume=2002 |pmid=12076499 |doi=10.1002/14651858.CD003676|pmc=6532671 }}</ref> Paracetamol should not be used solely to reduce body temperature; however, it may be considered for children with fever who appear distressed.<ref name=NICE>{{cite web |url= https://www.nice.org.uk/guidance/ng143/chapter/Recommendations#antipyretic-interventions |title= Recommendations. Fever in under 5s: assessment and initial management |website= nice.org.uk |date= 7 November 2019 |publisher=  |format=  |access-date=  |archive-date= 10 February 2021 |archive-url= https://web.archive.org/web/20210210232531/https://www.nice.org.uk/guidance/ng143/chapter/Recommendations#antipyretic-interventions |url-status= live }}</ref> It does not prevent [[febrile seizures]].<ref name=NICE/><ref name= "pmid33125519">{{cite journal |vauthors=Hashimoto R, Suto M, Tsuji M, Sasaki H, Takehara K, Ishiguro A, Kubota M |title=Use of antipyretics for preventing febrile seizure recurrence in children: a systematic review and meta-analysis |journal=Eur J Pediatr |volume=180 |issue=4 |pages=987–997 |date=April 2021 |pmid=33125519 |doi= 10.1007/s00431-020-03845-8 |doi-access= |title-link = doi |s2cid=225994044 }}</ref> It appears that 0.2{{nbsp}}°C decrease of the body temperature in children after a standard dose of paracetamol is of questionable value, particularly in emergencies.<ref name="pmid19058473"/> Based on this, some physicians advocate using higher doses that may decrease the temperature by as much as 0.7{{nbsp}}°C.<ref name="pmid26518691">{{cite journal |vauthors=de Martino M, Chiarugi A |title=Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management |journal=Pain Ther |volume=4 |issue=2 |pages=149–68 |date=December 2015 |pmid=26518691 |pmc=4676765 |doi=10.1007/s40122-015-0040-z}}</ref> Meta-analyses showed that paracetamol is less effective than ibuprofen in children (marginally less effective, according to another analysis<ref name="pmid28437025">{{cite journal |vauthors=Narayan K, Cooper S, Morphet J, Innes K |title=Effectiveness of paracetamol versus ibuprofen administration in febrile children: A systematic literature review |journal=J Paediatr Child Health |volume=53 |issue=8 |pages=800–807 |date=August 2017 |pmid=28437025 |doi=10.1111/jpc.13507 |s2cid=395470}}</ref>), including children younger than 2 years old,<ref name="pmid33125495">{{cite journal |vauthors=Tan E, Braithwaite I, McKinlay CJ, Dalziel SR |title=Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years: A Systematic Review and Meta-analysis |journal=JAMA Netw Open |volume=3 |issue=10 |pages=e2022398 |date=October 2020 |pmid= 33125495 |pmc=7599455 |doi=10.1001/jamanetworkopen.2020.22398}}</ref> with equivalent safety.<ref name="pmid20150507">{{cite journal |vauthors=Pierce CA, Voss B |title= Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review |journal=Ann Pharmacother |volume=44 |issue=3 |pages= 489–506 |date=March 2010 |pmid=20150507 |doi=10.1345/aph.1M332 |s2cid= 44669940}}</ref> [[Exacerbation]] of asthma occurs with similar frequency for both medications.<ref name= "pmid32293369">{{cite journal |vauthors=Sherbash M, Furuya-Kanamori L, Nader JD, Thalib L |title=Risk of wheezing and asthma exacerbation in children treated with paracetamol versus ibuprofen: a systematic review and meta-analysis of randomised controlled trials |journal=BMC Pulm Med |volume=20 |issue=1 |pages=72 |date=March 2020 |pmid= 32293369 |pmc=7087361 |doi=10.1186/s12890-020-1102-5 |doi-access=free }}</ref> Giving paracetamol and ibuprofen together at the same time to children under 5 is not recommended; however, doses may be alternated if required.<ref name= NICE/>