Update of the 2009 Italian Pediatric Society Guidelines about management of fever in children

Background: In 2009, the Italian Pediatric Society developed national guidelines for management of fever in children for health care providers and parents/caregivers; an update of these guidelines was scheduled after 2 years. Objective: This article summarizes the update of Italian guidelines on managing fever in children, focusing specifically on measuring body temperature and using antipyretic agents. Methods: Relevant publications in English and Italian were identified through searches of MEDLINE and the Cochrane Database of Systematic Reviews from January 1, 2008, to May 1, 2012. On the basis of consensus of a multidisciplinary expert panel, evidence levels and strength of recommendations were reviewed. Results: Axillary temperature measurement using a digital thermometer is recommended in children younger than 4 weeks. In the hospital or ambulatory care setting, axillary temperature measurement using a digital or infrared thermometer (tympanic or skin contact or nocontact) is recommended in children older than 4 weeks. Paracetamol and ibuprofen are the only antipyretic drugs recommended for use in children; however, combined or alternating use of these agents is not recommended. Conclusions: Recent scientific evidence mainly supports previous recommendations. The aim of the present article was to support pediatric knowledge and stimulate application of guidelines in daily clinical practice.