Comparison of national and international pediatric fever clinical practice guidelines: A systematic review
Abstract
BACKGROUND: Fever is one of the most common reasons for pediatric medical consultations worldwide. Although numerous clinical practice guidelines (CPGs) have been developed to support evidence-based fever management, variations in recommendations persist across national and international guidelines.
AIM: To compare recommendations from contemporary national and international pediatric fever CPGs and identify areas of consensus and divergence.
METHODS: A systematic literature search was conducted in MEDLINE, Scopus, Web of Science, the Cochrane Library, guideline repositories, and relevant organizational websites. National and international pediatric fever CPGs published or updated between January 1, 2010, and June 12, 2026, were eligible. Recommendations were extracted using a standardized form and grouped into four predefined domains: Temperature assessment, antipyretic therapy, physical methods, and caregiver education. Agreement across guidelines was classified as excellent (≥ 80%), partial (60%-79%), or low (< 60%).
RESULTS: Eleven CPGs met the inclusion criteria. Excellent agreement (≥ 80%) was observed for recommendations on the indication for antipyretic treatment, use of paracetamol and ibuprofen, and caregiver education (all 100%), as well as for avoiding the use of fever alone as an indicator of serious bacterial infection and against the use of antipyretics for the prevention of febrile seizures (both 91%). By contrast, recommendations on temperature measurement sites showed the greatest variability across guidelines. Partial agreement (64%) was observed for body temperature thresholds, vaccination prophylaxis, tepid sponging, and routine combined antipyretic therapy, while alternating antipyretic therapy showed the lowest agreement among antipyretic-related recommendations (55%). Recommended maximum daily paracetamol doses also varied substantially, ranging from 40 mg/kg/day to 90 mg/kg/day.
CONCLUSION: Contemporary pediatric fever CPGs show broad consensus on antipyretic therapy and caregiver education, but recommendations on temperature assessment, physical methods, and paracetamol dosing remain more variable, warranting harmonization.
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BibTeX
@article{pavlovic2026comparison,
title = {{Comparison of national and international pediatric fever clinical practice guidelines: A systematic review}},
author = {Momčilo T Pavlović and Karolina F Berenji and Zeljko L Rokvic},
journal = {World Journal of Clinical Pediatrics},
year = {2026},
month = nov,
doi = {10.5409/wjcp.125891},
url = {https://doi.org/10.5409/wjcp.125891},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Comparison of national and international pediatric fever clinical practice guidelines: A systematic review
AU - Momčilo T Pavlović
AU - Karolina F Berenji
AU - Zeljko L Rokvic
PY - 2026
DA - 2026/11/03
JO - World Journal of Clinical Pediatrics
DO - 10.5409/wjcp.125891
UR - https://doi.org/10.5409/wjcp.125891
AB - BACKGROUND: Fever is one of the most common reasons for pediatric medical consultations worldwide. Although numerous clinical practice guidelines (CPGs) have been developed to support evidence-based fever management, variations in recommendations persist across national and international guidelines. AIM: To compare recommendations from contemporary national and international pediatric fever CPGs and identify areas of consensus and divergence. METHODS: A systematic literature search was conducted in MEDLINE, Scopus, Web of Science, the Cochrane Library, guideline repositories, and relevant organizational websites. National and international pediatric fever CPGs published or updated between January 1, 2010, and June 12, 2026, were eligible. Recommendations were extracted using a standardized form and grouped into four predefined domains: Temperature assessment, antipyretic therapy, physical methods, and caregiver education. Agreement across guidelines was classified as excellent (≥ 80%), partial (60%-79%), or low (< 60%). RESULTS: Eleven CPGs met the inclusion criteria. Excellent agreement (≥ 80%) was observed for recommendations on the indication for antipyretic treatment, use of paracetamol and ibuprofen, and caregiver education (all 100%), as well as for avoiding the use of fever alone as an indicator of serious bacterial infection and against the use of antipyretics for the prevention of febrile seizures (both 91%). By contrast, recommendations on temperature measurement sites showed the greatest variability across guidelines. Partial agreement (64%) was observed for body temperature thresholds, vaccination prophylaxis, tepid sponging, and routine combined antipyretic therapy, while alternating antipyretic therapy showed the lowest agreement among antipyretic-related recommendations (55%). Recommended maximum daily paracetamol doses also varied substantially, ranging from 40 mg/kg/day to 90 mg/kg/day. CONCLUSION: Contemporary pediatric fever CPGs show broad consensus on antipyretic therapy and caregiver education, but recommendations on temperature assessment, physical methods, and paracetamol dosing remain more variable, warranting harmonization.
SN - 2219-2808
ER -