This protocol addresses the acute management of a febrile seizure in a child aged above 3 years. Children in this age group have specific approved treatment options for seizure termination that inform the structured approach below.
The recommended approach is rescue therapy to terminate the seizure as promptly as possible. Benzodiazepines are the first-choice intervention in this setting, with the response assessed at a defined time point after the initial dose to guide further management.
The full regimen — including agent selection, age-specific dosing, route of administration, and the complete decision algorithm — is available in the structured protocol.
With this in mind, buccal midazolam (MDZ) and rectal diazepam (DZP) are the first choice as rescue therapy.
In Italy, buccal MDZ has received approval for the treatment of prolonged febrile seizures in children aged above three years and should be administered at a dose of 0.5 mg/kg with pre-dosed syringes formulations (3–4 years: 5 mg; 5–9 years: 7.5 mg; 10–18 years: 10 mg).
After a first dose of BDZ, a second one could be administered after 5 min if the FS has not stopped.
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