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Health Protection Agency advice on antipyretics contradicts NICE guideline
- Gina Johnson (15 July 2009)
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Using antipyretics with Influenza or Swine Flu
- Hilary Butler (16 July 2009)
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Yet another death after paracetamol.
- Hilary Butler (28 July 2009)
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Gina Johnson, General Practitioner National Minor Illness Centre, Luton, England LU2 7HR
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Julius Wagner-Jauregg won the Nobel prize in 1927 for developing an effective treatment for syphilis which entailed deliberately infecting patients with malaria. This research suggests that fever may be a beneficial response to infection. The 2007 NICE guideline on feverish illness in children under five(1)reviewed the sparse evidence on using antipyretic medicines, which seems to indicate that artificially lowering a fever may reduce the immune response and prolong illness. NICE therefore recommended "Do not routinely give antipyretic drugs to a child with fever with the sole aim of reducing body temperature". A small trial on the use of antipyretics in an intensive care unit(2) was stopped because the mortality rate was 16% in the treated group and 1% in the group from whom antipyretics were withheld. The existing evidence suggests that antipyretics should be avoided in patients with pandemic flu, and yet the Health Protection Agency continues to recommend their routine use(3). We urgently need more research into the potential harmful effects of antipyretic medicines. When will the large- scale randomised controlled trials be done? References: 1. Feverish illness in children - Assessment and initial management in children younger than 5 years. NIHCE guideline 47, 2007. http://www.nice.org.uk/nicemedia/pdf/CG47QuickRefGuide.pdf, accessed 15/7/2009 2. The Effect of Antipyretic Therapy upon Outcomes in Critically Ill Patients: A Randomized, Prospective Study. Schulman CI, Namias N, Doherty J, Manning RJ, Li P, Alhaddad A et al. Surgical Infections. Winter 2005, 6(4): 369-375. doi:10.1089/sur.2005.6.369. 3. Summary of prescribing guidance for the treatment and prophylaxis of influenza-like illness: Treatment Phase, Appendix Five ver 1.5. Health Protection Agency, 2009. http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1243581475043, accessed 15/7/09 Competing interests: None declared |
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Hilary Butler, Freelance journalist home, Tuakau 2121, New Zealand.
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Dear Sir, In 2000, Plaisance et al proved that the use of paracetamol increased viral shedding and significantly prolonged the duration of influenza. (1) In 1992, (2)Shalabi et al, showed that acetaminophen seriously inhibits polymorphonuclear leukocytes, and scavenges available HOCl... paralysing the MPT-H2)2-Cl- antimicrobial system of PMNs and inhibited superoxide anion generation as well as degranulation of PMNs. Given, as Shalabi says, that PMN's play a crucial role in fighting bacterial, viral and parasitic infections, why is paracetamol used during infectious fevers? Four years later, Shalabi et al again pointed out that the higher the temperature, the more severely acetaminophen inhibited bacterial activity of PMNs. (3) The medical literature since 1975 is replete with articles showing that reducing fever during many different infections increases both complications and mortality. Even WHO admits this. (4) So why does every single country recommend paracetamol (acetaminophen) for routine treatment of any influenza, or indeed, any infection at all? Meanwhile back in the UK in 2004 (5), Eccles et al state that: "Despite the lack of clinical data on the safety and efficacy of analgesics for the treatment of colds and flu symptoms a case can be made that these medicines are safe and effective for treatment of these common illnesses." Perhaps the question should also be asked as to why any deaths, potentially augmented, or even caused by the use of antipyretics inhibitting parts of the immune system... are then used to justify the roll-out of a vaccine? Hilary Butler. (1)Pharmacotherapy. 2000 Dec;20(12):1417-22. PMID: 11130213 (2) Immunopharmacology. 1992 Jul-Aug;24(1):37-45. PMID: 1333457 (3)Biopharm Drug Dispos. 1996 Aug;17(6):501-9. PMID: 8866041 (4) Evidence on the use of paracetamol in febrile children. Bull World Health Organ [online]. 2003, vol.81, n.5, pp. 367-372. ISSN 0042-9686. doi: 10.1590/S0042-96862003000500011. http://www.scielosp.org/scielo.php?script=sci_abstract&pid=S0042- 96862003000500011&lng=en&nrm=iso&tlng=en (5) J Clin Pharm Ther. 2006 Aug;31(4):309-19. Review. PMID: 16882099 Competing interests: None declared |
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Hilary Butler, Freelance Journalist Home, Tuakau 2121, New Zealand.
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Dear Sir, The silence following previous queries, is resounding. Yet, we continue to read stories like this, daily, from all around the world: "The Ministry of Health says expectant mums who get symptoms should stay home and limit contact with others especially if they are ill, drink plenty of fluids, call their GP or healthline for advice and treat fever straight away with paracetamol." (1) so it's natural to then read: "... the mother-of-two Alma Palmer had been sent home from hospital with paracetamol, a day before collapsing and being airlifted to the mainland. "I am angry with the hospital," her grandfather Roderick Geesu was quoted as saying. "She went to the hospital and instead of giving her a thorough check-up they gave her a packet of Panadol (paracetamol)." (2) No doubt the experts will say that OF COURSE all deaths had been taking paracetamol. Standard protocol. "So of course paracetamol has NOTHING to do with the deaths." Right???? Like Dr Johnson says, when will large scale randomised trials begin? Why is it, that standard advice flies in the face of both medical literature, principles of immunology, and common sense? Where is the evidence based science to justify such routine pronouncements? And "coincidental" dismissals? Hilary Butler. (1) http://tvnz.co.nz/health-news/swine-flu-fears-pregnant-women- 2851450 (2) http://www.bangkokpost.com/news/asia/149784/australia-trials-flu- vaccine-as-world-toll-leaps Competing interests: None declared |
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