Emergency Department, Alkhor Hospital, Qatar.
Ther Clin Risk Manag. 2013;9:371-6. doi: 10.2147/TCRM.S45802. Epub 2013 Oct 3.
Fever is a common problem in adults visiting the emergency department. Extensive studies have been done in children comparing the efficacy of various antipyretics. However, studies on the efficacy of antipyretic drugs in adults are very scarce. To the best of our knowledge, no controlled trial has been carried out comparing the antipyretic efficacy of paracetamol (oral and intravenous) and intramuscular diclofenac in adults.
In this parallel-group, open-label trial, participants aged 14-75 years presenting with fever who had a temperature of more than 38.5°C were enrolled and treated. Participants were randomly allocated to receive treatment with 1,000 mg oral paracetamol (n = 145), 1,000 mg intravenous paracetamol (n = 139), or 75 mg intramuscular diclofenac (n = 150). The primary outcome was degree of reduction in mean oral temperature at 90 minutes. The efficacy of diclofenac versus oral and intravenous paracetamol was assessed by superiority comparison. Analysis was done using intention to treat principles.
After 90 minutes, all three groups showed a significant reduction in mean temperature, with intramuscular diclofenac showing the greatest reduction (-1.44 ± 0.43, 95% confidence interval [CI] -1.4 to -2.5) and oral paracetamol the least (-1.08 ± 0.51, 95% CI -0.99 to -2.2). After 120 minutes, there was a significant difference observed in the mean change from baseline temperature between the three treatment groups (P < 0.0001). Significant changes in temperature were observed in favor of intramuscular diclofenac over oral and intravenous paracetamol at each time point from 60 minutes through 120 minutes inclusive.
Both intramuscular diclofenac and intravenous paracetamol showed superior antipyretic activity than oral paracetamol. However, in view of its ease of administration, intramuscular diclofenac can be used as a first-choice antipyretic in febrile adults in the emergency department.
发热是急诊科成人患者常见的问题。已经有大量研究比较了各种解热药在儿童中的疗效。然而，关于成人解热药疗效的研究非常匮乏。据我们所知，尚未开展过比较对乙酰氨基酚（口服和静脉）和肌肉注射双氯芬酸在成人中的解热疗效的对照试验。
在这项平行组、开放标签试验中，纳入了体温超过 38.5°C 且年龄在 14-75 岁之间的发热患者，并对其进行了治疗。将参与者随机分配接受 1000 mg 口服对乙酰氨基酚（n = 145）、1000 mg 静脉用对乙酰氨基酚（n = 139）或 75 mg 肌肉注射双氯芬酸（n = 150）治疗。主要结局是 90 分钟时平均口腔温度的降低程度。通过优势比较评估双氯芬酸相对于口服和静脉用对乙酰氨基酚的疗效。分析采用意向治疗原则。
90 分钟后，三组的平均体温均显著降低，肌肉注射双氯芬酸的降幅最大（-1.44 ± 0.43，95%置信区间[CI] -1.4 至-2.5），口服对乙酰氨基酚的降幅最小（-1.08 ± 0.51，95% CI -0.99 至-2.2）。120 分钟时，三组之间从基线体温的平均变化存在显著差异（P < 0.0001）。从 60 分钟到 120 分钟，体温均有显著变化，与口服和静脉用对乙酰氨基酚相比，肌肉注射双氯芬酸的优势明显。
肌肉注射双氯芬酸和静脉用对乙酰氨基酚均显示出优于口服对乙酰氨基酚的退热活性。然而，鉴于其给药的便利性，肌肉注射双氯芬酸可作为急诊科发热成人的首选解热药。
