MISC: Hilary on Anti-Pyretics

September 19, 2008

From a knowledgable associate........

PARACETAMOL. (USA TYLENOL,IBUPROFEN etc)

Your child is scratchy, your child has a temperature, your child is

irritable, and you ring the doctor's surgery, and the voice on the other

end says what it always says " " Just give Pamol, dear, and come back

tomorrow if you are still worried.

What is the purpose of fever? What do parents believe about fever? Should

it be treated with antipyretics? Why do doctors prescribe antipyretics?

What does the medical literature say about the biological impact of

paracetamol?

Antipyretics are also recommended prior to vaccination, though in this

country, this advice is given hesitantly, since there is debate that

antipyretics could " conceal " medically significant symptoms, and confuse

diagnosis.

EXTRACTS FROM MEDICAL LITERATURE:

" Not all fevers need to be treated but many physicians do so to relieve

parental concern. " (Eur J Ped 1994 Jun; 153 (6): 394-402)

" An elevation in temperature following bacterial infection results in a

significant increase in host survival " (Science 1975 Apr 11; 188 (4184):

166-8)

" Many components of the nonspecific host defence response to infection such

as leukocyte mobility, lymphocyte transformation, and the effects of

interferon, appear to be enhanced by elevations in temperature that

simulate moderate fevers. In addition, some evidence indicates that a fever

in conjunction with the changes in plasma iron levels known to occur during

infections is a synergistic host defence response. " (Pediatrics 1980, No:

66 (5) : 720 - 723)

" Parental fever phobia and its correlates...surprising, higher

socioeconomic status was not associated with a lesser degree of fever

phobia...undue fear and overly aggressive treatment of fever are epidemic

among parents of infants and young children, even among the highly educated

and well-to-do. considerable effort will be required on the part of

pediatricians and other child health workers to reeducate that parents

about the definition, consequences and appropriate treatment of fever. "

(Pediatrics 1985 June;75 (6) 1110-1113)

" There is no convincing evidence that naturally occuring fevers are

harmful. In contrast, animal studies have shown that fever helps animals to

survive and infection whereas antipyretic increases mortality. Moreover

there is considerable in vitro evidence that a variety of human

immunological defences function better at febrile temperatures than at

normal one. " (The Lancet, Volume 337, March 9, 1991)

" Many cytokines are endogenous mediators of fever including interleukin

(IL) -, 1 beta, IL-6 and others. Tumor necrosis factor-alpha may be both an

endogenous pyrogen and an endogenous antipyretic or cryogen. "

(Neuroimmunomodulation 1995 Jul-Aug; 2 (4):216-223)

" There is overwhelming evidence in favor of fever being an adaptive host

response to infection... as such, it is probable that the use of

antipyretic/anti-inflammatory/analgesic drugs, when they lead to

suppression of the fever, result in increased morbidity and mortality

during most infections; this morbidity and mortality may not be apparent to

most health care workers... " Infect Dis Clin North Am 1996 Mar;10(1) : 1-20.)

Acetaminophen can induce pneumonia... " These finding suggest that allergic

mechanism was involved in the pathogenesis of the pneumonitis. Underlying

immunological disorders may have enhanced the occurrence. " Nihon Kyobu

Shikkan Gakkai Sasshi 1997 Sep; 35 (9) 974-9) There are other reports of

this as well...

" the results suggest that lung disease (rheumatoid lung) associated with

collagen vascular diseases may be exacerbated by drug-induced

(acetaminophen) pneumonitis. " Nihon Kyobu Shikkan Gakkai Sasshi 1997 Oct;

35 (10) 1113-1118)

" Despite our lack of knowledge about its therapeutic mechanism, it has been

claimed to be a safe drug, especially for children... paracetamol syrup

(presumably for children) is extensively prescribed in large

volumes...There is mounting evidence that paracetamol is not the benign

drug that it was formally thought to be... We would question the whole

rationale of prescribing the drug in near epidemic proportions. If it is to

be used as a placebo, then it is a very dangerous placebo... The whole

place of paracetamol prescribing for children has been questioned. While

there is little concern about its use in the short term as an analgesic,

there is considerable controversy over its use as an antipyretic....there

is little evidence to support the use of paracetamol to treat fever in

patients without heart or lung disease. Paracetamol may decreast antibody

response to infection and increase morbidity and mortality in severe

infections...too many parents and health workers think that fever is bad

and needs to be suppressed by paracetamol when, indeed, moderate fever may

improve the immune response...the use of paracetamol in children with acute

infection did not result in an improvement in mood, comfort, appetite or

fluid intake. " (Family Practice, Volume 13, No 2, 1996 pgs 179 - 181)

" Fever is rarely harmful. Only extremely high fevers of 42.2C or 108 F or

higher have been known to cause brain damage. Only fevers of 40.5C or 105F

and higher need immediate attention, mainly because they are a clue that a

serious infection could be present " (such as meningitis) (Sunday Star

Times, May 3, 1998, C3) doctor's column.

" Paracetamol has no antipyretic benefits over mechanical antipyreses alone

in ..malaria. Moreover, paracetamol prolongs parasite clearance time,

possible by decreased production of TNF and oxygen radicals. " (Lancet

1997;350:704-709)

" The data suggest that frequent administration of antipyretics to children

with infectious disease may lead to a worsening of their illness. " (Acta

Paed. Jpn 1994 Aug;36 (4) 375-378)

" Fever is an important indicator of disease and should not be routinely

suppressed by antipyretics...fever may actually benefit the host defense

mechanism...fever is short-lived and causes only minor discomfort...routine

antipyretic therapy should be avoided byt may be necessary in individual

patients with cardiovascular or neurologic disorders. " (Infect Dis Clin

North Am 1996 Mar;10 (1) 211-216)

" Studies of bacterial and viral-infected animals have shown that moderate

fevers decrease morbidity and increase survival rate " (Yale J Biol Med 1986

Mar-April; 59 (2) : 89-95)

" Antipyretic drugs are effective in diminishing fever, but have significant

side effects and may suppress signs of ongoing infections " (Arch Intern Med

1990, Aug; 150 (8): 1589-1597)

Meningococcal Disease: " use of analgesics were associated with

disease...analgesic use was defined as analgesics taken in the past 2

weeks, excluding, for cases, those taken for identified early symptoms of

meningococcal disease. These analgesics were predominantly acetaminophen

products......because analgesics showed a stronger relationship with

meningococcal disease, the use of analgesics may be a better measure of

more severe illness than reported individual symptoms....we cannot exclude

the possibility that acetaminophen use itself is a risk factor for

meningococcal disease " (Ped Infec Dis, Oct 2000, Vol 19, No 10, 983-990)

" Antipyretics prolong illness in patients with Influenza A.... The duration

of illness was significantly prolonged from 5 days(without) to 8 1/2 days

(with). Pharmacotherapy 2000, 20: 417-422)

Take two aspirin, prolong the flu - 2 January 2001 Anne Burke, HealthScout

Reporter (also reported by Reuters medical news...) " Taking aspirin or

Tylenol for the flu actually prolongs the illness by up to 3 1/2 days, say

researchers at the University of land. That is because fever may be the

body's natural way of fighting an infection and taking aspirin or

acetaminophen - the generic name for products such as Tylenol - may

interefere with the process. " You are messing with Mother Nature, " Says Dr

Leland Rickman, an associate clinical professor of medicine at the

University of California San Diego. " An elevated temperature may actually

help the body fight the infection quicker or better than if you don't have

a fever. "

" Whatever you do, don't give aspirin or Tylenol to children who have the

flu or any other viral illness " , Rickman said end quote.

" These results suggest that the systematic suppression of fever may not be

useful in patients without severe cranial trauma or significant hypoxemia.

Letting fever take its natural course does not seem to harm patients with

systemic inflammatory response syndrome, or influence the discomfort level

AND MAY SAVE COSTS. " (wow!!!) (Arch Intern Med 2001, Jan 8; 161 (1) 121-123)

Chickenpox treated with Tylenol/Ibuprofen provokes bacterial skin

infections into fulminant necrotising fasciitis (Pediatr I(Pediatrics Vol

103, No 4, April 1999, 783-784 and 785-790) (Infect Med1999 16 (5):307)

Just two of many references for antipyretic induced complications of

chickenpox.

(In MMWR - May 15, 1998, Vol 47 No 18. All cases of Varicella related

deaths were treated with antipyretics. No causal association was

investigated or ascribed. The " solution " to the problem was considered to

be mandatory vaccination.)

What you do as a parent, is your choice. Make sure that it is an " informed "

choice. Get the articles referenced, do a med-line search - retrieve any

others. REad the whole articles. Give them to your doctor to read, and

discuss them with him/her. Most importantly, if you feel your child has an

immunodeficiency, get your child tested so that you know what you are

dealing with.

How a child handles any infectious disease is dependant upon the immune

system inherited, nutritional status, life-style, environment and resultant

stresses and how the child reacts to them.

The choice is yours.

July 7, 2009

's article on antipyretics.

-- MISC: on Anti-Pyretics