title: Enduring large use of acetaminophen suppositories for fever management in children: a national survey of French parents and healthcare professionals' practices.
abstract: The pharmacological specificities of the rectal formulation of acetaminophen led to a debate on its appropriateness for managing fever in children, but few data are available on the formulation's current use and determinants of use. In a national cross-sectional study between 2007 and 2008, healthcare professionals were asked to include five consecutive patients with acute fever. Among the 6255 children (mean age 4.0 years ± 2.8 SD) who received acetaminophen given by parents or prescribed/recommended by healthcare professionals, determinants of suppository use were studied by multilevel models. A suppository was given by 27 % of parents and prescribed/recommended by 19 % of healthcare professionals, by 24 and 16 %, respectively, for children 2 to 5 years old, and by 13 and 8 %, respectively, for those 6 to 12 years old. Among children who received suppositories from parents and healthcare professionals, 83 and 84 %, respectively, did not vomit. Suppository use was independently associated with several patient- and healthcare professional-level characteristics: young age of children, presence of vomiting, or lack of diarrhea.
  
  
  CONCLUSIONS
  We report an enduring large use of suppositories in France for the symptomatic management of fever in children, including in non-vomiting and/or older children. The rational for such use should be questioned.
  
  
  BACKGROUND
  • The pharmacological specificities of the rectal formulation of acetaminophen have led to a debate on its appropriateness for managing fever in children. Few data are available on the formulation's current use and determinants of the use. What is New: • In a national cross-sectional study, we observed a large use of suppositories in France for symptomatic management of fever in children. Suppositories were frequently used for the youngest children but also for older and/or non-vomiting children.
authors.affiliation: Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France. nathalie.bertille@inserm.fr.|Sorbonne Universités, UPMC Univ Paris 06, IFD, Paris, France. nathalie.bertille@inserm.fr.|Department of General Pediatrics, Hôpital Necker-Enfants malades, Assistance publique - Hôpitaux de Paris (AP-HP), Paris-Descartes University, Paris, France. nathalie.bertille@inserm.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bertille
authors.affiliation: Pain center, Hôpital Bicêtre, AP-HP, Kremlin-Bicêtre, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Fournier-Charrière
authors.affiliation: Clinical Pharmacology, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris-Descartes University, Paris, France.|Inserm U663 Pediatric epilepsies and brain plasticity, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Pons
authors.affiliation: Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France.
authors.forename: Babak
authors.initials: B
authors.lastname: Khoshnood
authors.affiliation: Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, 53 avenue de l'Observatoire, 75014, Paris, France.|Department of General Pediatrics, Hôpital Necker-Enfants malades, Assistance publique - Hôpitaux de Paris (AP-HP), Paris-Descartes University, Paris, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000285:Administration, Rectal; D058633:Antipyretics / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000188:drug therapy*; D005602:France; D006282:Health Personnel; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D010290:Parents; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013488:Suppositories; D011795:Surveys and Questionnaires
chemical_list: D058633:Antipyretics; D013488:Suppositories; D000082:Acetaminophen
keywords: Acetaminophen; Fever; Formulation; France; Healthcare professional; Parents