[cobluegirl]

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)16-223)

"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 Maryland. 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.)

To the parents on this board:

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. 90% of that, you can control, but to do that, you have to have the knowledge to do so. Which is something most doctors trained today, don't have. Their speciality is cross-references the "perceived" symptoms with the most up to date physicians desk reference, and writing a drug prescription. Which is, in my opinion, not the best or even the right way to create healthy children.

And remember too, I have an immunodeficiency, as does one of my children. So I am not talking out of my left ear.

The choice is yours.