TY - JOUR T1 - Use of non-steroidal anti-inflammatory drugs in paediatrics JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed DO - 10.1136/archdischild-2019-317228 SP - edpract-2019-317228 AU - Rosie Close AU - Peter Bale AU - Kate Armon Y1 - 2020/02/07 UR - http://ep.bmj.com/content/early/2020/02/07/archdischild-2019-317228.abstract N2 - Non-steroidal anti-inflammatory drugs (NSAIDs) do exactly what they say on the tin, they are not steroid medications and act to decrease inflammation. Finding an alternative to corticosteroid treatment for rheumatoid arthritis drove the discovery of ibuprofen in 1961.Ibuprofen is the most commonly prescribed paediatric NSAID in the UK and the second most commonly prescribed paediatric inpatient medication (after paracetamol).1All NSAIDs exert their clinical effects by inhibiting prostaglandin synthesis. Prostaglandins modulate components of the immune system and are involved in the control of body temperature, pain transmission, platelet aggregation and gastric protection. The primary site of action is the inhibition of the cyclooxygenase (COX) enzyme, which exists in two isoforms (Cox-1 and Cox-2). Selective inhibition of Cox-2 is associated with less gastrointestinal (GI) intolerance. It has also been hypothesised that COX-2 plays a role in the inflammation process, hence drugs that selectively inhibit COX-2 enzymes should have the beneficial anti-inflammatory activity of traditional NSAIDS without the toxicity. Experience with COX-2 inhibitors in paediatric patients is limited. COX-2 inhibitors are more expensive, and the debate over their safety and efficacy compared with traditional NSAIDs is not yet concluded. Meloxicam and celecoxib have proven to be effective and safe in children with musculoskeletal disorders in a controlled trial2After oral administration, the absorption of NSAIDs is generally rapid and complete with most occurring in the stomach and upper small intestine. NSAIDs are highly bound to plasma proteins, specifically to albumin (>90%). All NSAIDs can be found in synovial fluid after repeated dosing, and ibuprofen also has the ability to penetrate the CNS.3Members of the class (with formulations) are listed in table 1.View this table:In this windowIn a new windowTable 1 NSAID overview for pain and inflammation.FeverThere have been many studies comparing the efficacy, safety and tolerability of paracetamol and ibuprofen for pain and … ER -