Pai Uday, Venkata Ravishankar A, Shah Abhay, Gupta Alok, Clement Antony, Wadhwa Arun, Kumar Ashwani, Somasundaram A, Charde Girish, Joshi K K, Sanklecha Mukesh, Suresh Kumar Mylapore V, Gokhale Praveen, Agarwal Rajeev, Shah Raju, Chhabra Ritesh, Niranjan Sanjay, Dudhgaonkar Shilpa, Surampudi Srikrishna, Nayak Sumitha, Borkar Vibhor V
Department of Pediatrics, Sai Kutir Clinic, Mumbai, IND.
Department of Pediatrics, Dr. Ravishankar Clinic, Chennai, IND.
Cureus. 2025 Jul 21;17(7):e88412. doi: 10.7759/cureus.88412. eCollection 2025 Jul.
Fever and pain are among the most common reasons for pediatric consultations, requiring effective and safe management strategies. Mefenamic acid, a well-established member of the nonsteroidal anti-inflammatory drug (NSAID) class, offers distinct advantages due to its unique pharmacological profile, including preferential cyclooxygenase-2 (COX-2) inhibition, E-type prostanoid (EP) receptor blockade, and nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome inhibition. These properties enable it to address both inflammatory and non-inflammatory fevers, providing comprehensive symptom relief. Despite its proven efficacy, the absence of pediatric-specific guidelines and perceived concerns about safety have limited its routine use in pediatric practice. This consensus paper, developed through a structured modified Delphi process involving 21 expert pediatricians across India, aims to address these gaps. The paper evaluates the safety, efficacy, and clinical applications of mefenamic acid, providing evidence-based best-practice recommendations. Highlights include its superior antipyretic efficacy compared to paracetamol and ibuprofen, with preclinical and limited clinical data suggesting potential antiviral activity, and a possible role in the management of febrile seizures and inflammatory conditions. While mefenamic acid demonstrates a favorable safety profile with appropriate use, further research is necessary to strengthen the evidence on long-term safety and expand its therapeutic scope. This consensus provides a comprehensive framework for optimizing the use of mefenamic acid in pediatric practice, ensuring improved patient outcomes. The long-term safety of mefenamic acid in children is still unclear, due to the limited availability of robust, longitudinal safety data. Future research should prioritize well-powered clinical trials, particularly in children aged six months to five years, using standardized outcome measures and long-term follow-up protocols. Addressing these evidence gaps is important to inform safe and effective use in pediatric practice.
发热和疼痛是儿科就诊的最常见原因之一，需要有效的安全管理策略。甲芬那酸是一种成熟的非甾体抗炎药（NSAID），因其独特的药理特性具有明显优势，包括对环氧化酶-2（COX-2）的优先抑制、E型前列腺素（EP）受体阻断以及核苷酸结合寡聚化结构域样受体蛋白3（NLRP3）炎性小体抑制。这些特性使其能够应对炎性和非炎性发热，全面缓解症状。尽管其疗效已得到证实，但缺乏针对儿科的指南以及对安全性的担忧限制了其在儿科临床实践中的常规使用。这篇共识文件是通过印度21位儿科专家参与的结构化改良德尔菲法制定的，旨在弥补这些差距。该文件评估了甲芬那酸的安全性、有效性及临床应用，提供基于证据的最佳实践建议。亮点包括其与对乙酰氨基酚和布洛芬相比具有更优的退热效果，临床前及有限的临床数据表明其可能具有抗病毒活性，以及在热性惊厥和炎性疾病管理中可能发挥的作用。虽然甲芬那酸在合理使用时显示出良好的安全性，但仍需进一步研究以加强长期安全性证据并扩大其治疗范围。这一共识为优化甲芬那酸在儿科临床实践中的使用提供了全面框架，确保改善患者预后。由于可靠的纵向安全性数据有限，甲芬那酸在儿童中的长期安全性仍不明确。未来研究应优先开展有足够样本量的临床试验，尤其是针对6个月至5岁儿童，采用标准化结局指标和长期随访方案。填补这些证据空白对于指导其在儿科临床实践中的安全有效使用非常重要。
