HPA advice on antipyretics contradicts NICE guideline

doi:10.1136/bmj.b3050

Published 28 July 2009, doi:10.1136/bmj.b3050
Cite this as: BMJ 2009;339:b3050

Letters

A/H1N1 flu

HPA advice on antipyretics contradicts NICE guideline

Julius Wagner-Jauregg won the Nobel prize in 1927 for developingan effective treatment for syphilis which entailed deliberatelyinfecting patients with malaria. This research suggests thatfever may be a beneficial response to infection. The 2007 guidelinefrom the National Institute for Health and Clinical Excellence(NICE) on feverish illness in children under 5 reviewed thesparse evidence on using antipyretic medicines, which seemsto indicate that artificially lowering a fever may reduce theimmune response and prolong illness. NICE therefore recommended,"Do not routinely give antipyretic drugs to a child with feverwith the sole aim of reducing body temperature."¹

A small trial on the use of antipyretics in an intensive careunit was stopped because mortality was 16% in the treated groupand 1% in the untreated group.²

The existing evidence suggests that antipyretics should be avoidedin patients with pandemic flu,³ yet the Health Protection Agency(HPA) continues to recommend their routine use.⁴ We urgentlyneed more research into the potential harmful effects of antipyreticmedicines. When will the large scale randomised controlled trialsbe done?

Cite this as: BMJ 2009;339:b3050

Gina Johnson, general practitioner¹

¹ National Minor Illness Centre, Luton LU2 7HR

johgina{at}gmail.com

Competing interests: None declared.

References

National Institute for Health and Clinical Excellence (NICE). Feverish illness in children. Assessment and initial management in children younger than 5 years. NICE guideline 47, 2007. www.nice.org.uk/nicemedia/pdf/CG47QuickRefGuide.pdf
Schulman CI, Namias N, Doherty J, Manning RJ, Li P, Alhaddad A, et al. The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study. Surgical Infections 2005;6:369-75. doi: 10.1089/sur.2005.6.369 [CrossRef][Medline]
Hama R. NSAIDs and flu. BMJ 2009;338:b2345. (15 June.)[Free Full Text]
Health Protection Agency. Summary of prescribing guidance for the treatment and prophylaxis of influenza-like illness: treatment phase, appendix five, version 1.5, 2009. www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1243581475043