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General practice Terapia 2023, 11 ( 430 ) :  54  -  62

The use of symptomatic drugs in respiratory infections according to the 2016 Recommendation for the management of community-acquired respiratory infections of the National Antibiotic Protection Program. Part III. Proposals for corrections and additions in anti-pain and antipyretic treatment

Summary: The Chapter 11 of the Recommendations 2016 on the management of the Community Acquired Respiratory Infections is devoted to the reductions or alleviation of pain, fever and cough as the leading symptoms resulted from the inflammatory process in the respiratory tract. This part of our corrective proposals is directed on the management of pain and fever. In the Recommendation 2016 ibuprofen and paracetamol had been the only recommended drugs. Multimodal combinations of these drugs had been barely mentioned. This duet in the new Recommendation should be completed with metamisol ‒ strong analgesic, antipyretic and also antispasmodic drug as well as nonsteroidal antyinflammatory drug (NSAID) naproxen, indicated for patients with associated cardiologic and hypercoagublity problems. In the course of respiratory infections pain and fever are important but usually not very serious problem; the associated pain is usually evaluated as a mild (1‒3 in NRS score) or a moderate (4‒6 in NRS score), rarely as strong pain (7‒10 in NRS score) e.g Acute Otitis Media. Therefore in the ambulatory practice and in majority patients hospitalised for respiratory tract infections analgesics (paracetamol and metamisol) and NSAIDs ibuprofen and naproxen in various combinations as multimodal analgesia and antipyrexia are panel of drugs satisfactorilly controlling pain and fever. Ibuprofen combined with paracetamol is an ideal and practically tested example of synergistic actions. Metamizol combined with paracetamol makes strong additive analgesic and antipyretic effects. Such multimodal strategy make possible to avoid opioid application as second or third step of analgesic ladder. It is officialy described as Opioid Free Analgesia (OFA) and should be considered as Recommended Strategy in new edition of Recommendation.
Keywords: pain, fever, ibuprofen, paracetamol, metamizole, naproxen

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