Fever and Tylenol

[Mirzam]

Did anyone save that wonderful post she wrote, or does anyone know if she has an article on the subject posted anywhere?

Thanks

[Sasha_girl]

http://www.*********/a/west8.html

Hope this helps.

[Mirzam]

Originally Posted by Sasha_girl

http://www.*********/a/west8.html

Hope this helps.

Thank you! It does help.

[Momtezuma Tuatara]

A few more detailed, useful medical articles, extracts and URLs.

According to fda Tylenol is not safe.

http://www.fda.gov/ohrms/dockets/ac/...d-Karwoski.ppt

Now, consider this:

http://www.fda.gov/fdac/features/2001/301_liver.html

FDA lists Tylenol as a drug with "limitations".

The WHO says that the use of antipyretics is dangerous

http://www.scielosp.org/scielo.php?s...lng=en&nrm=iso



We call Tylenol "Paracetamol". And its very dangerous.

Have a look at what this guy says:

http://www.australianprescriber.com/...aracetamol.htm

Antipyretics may be harmful

Immunity
Too many parents and health workers think that infection is bad, infection causes fever, and that therefore fever is bad. In fact, fever is often a beneficial host response to infection, and moderate fever improves immunity.11 Therefore, it may not be a good idea to give drugs that reduce temperature to patients with severe infection. I have recently reviewed 1 the results of 9 controlled trials in mammals of the effect of paracetamol or aspirin on mortality or virus excretion. Four trials found that aspirin increased mortality in bacterial or viral infection. Viral shedding was increased by paracetamol or aspirin in 3 studies, possibly increased in one, and not affected in two (one used only pharyngeal washings, and one had only 9 subjects in the aspirin and placebo groups). One study found that antibody production was impaired by both paracetamol and aspirin, but no effect on antibody production was detected in the study with only 9 subjects in the aspirin and placebo groups. This evidence suggests that aspirin and paracetamol increase mortality in severe infection, and that they may prolong the infection and reduce the antibody response in mild disease.
....

It should be explained to parents that fever is usually a helpful response to infection, and that paracetamol should be used to reduce discomfort, but not to treat fever.

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15239078

Acetaminophen overdose is the leading cause for calls to Poison Control Centers (>100,000/year) and accounts for more than 56,000 emergency room visits, 2,600 hospitalizations, and an estimated 458 deaths due to acute liver failure each year. Data from the U.S. Acute Liver Failure Study Group registry of more than 700 patients with acute liver failure across the United States implicates acetaminophen poisoning in nearly 50% of all acute liver failure in this country. Available in many single or combination products, acetaminophen produces more than 1 billion US dollars in annual sales for Tylenol products alone. It is heavily marketed for its safety compared to nonsteroidal analgesics. By enabling self-diagnosis and treatment of minor aches and pains, its benefits are said by the Food and Drug Administration to outweigh its risks. It still must be asked: Is this amount of injury and death really acceptable for an over-the-counter pain reliever?

According to the BMJ 2002;325:678 ( 28 September ) http://bmj.bmjjournals.com/cgi/conte...l/325/7366/678,

FDA fails to reduce accessibility of paracetamol despite 450 deaths a year

Confidential documents from the US Food and Drug Administration suggest that the agency has avoided a debate on tough new measures to reduce overdoses from painkillers to avoid offending the pharmaceutical industry. Ray Moynihan reports from Washington, DC

“ A confidential draft document reveals that the Office of Drug Safety also wanted the advisory panel to discuss whether the "maximum tablet strength should be decreased," whether "combination products be reformulated without acetaminophen," and whether there was "a need to standardize the various paediatric formulations."

The advisers never saw that draft, however, and none of these key options ended up being clearly presented to the committee by the FDA in the final list of questions they were to consider.

.... "The committee would have preferred more focused questions," he said.

According to one FDA insider, the draft questions were dropped because senior FDA managers saw them as too offensive to Johnson & Johnson. Asked about this alleged corporate influence within the FDA, Dr Cantilena smiled and said he did not want to speculate.

The Neurologic basis of fever,
Saper, Clifford B.
The New England Journal of Medicine, vol. 330, No. 26. June 30, 1994,

Page 1880:

“The elevation of body temperature by a few degrees may improve the efficiency of macrophages in killing invading bacteria, whereas it (fever) impairs the replication of many microorganisms, giving the immune system an adaptive advantage.

There is a simultaneous switch from the burning of glucose, an excellent substrate for bacterial growth, to metabolism based on proteolysis and lipolysis. The host organism also becomes anorexic, which minimizes the availability of glucose, and somnolent, which reduces the demand by muscles for energy substrate. During the febrile response, the liver produces proteins known as acute-phase reactants. Some of these proteins bind divalent cations, which are necessary for the proliferation of many microorganisms.

The net effect of the metabolic responses activated during fever is to give the host organism an adaptive advantage over the invader.”

Antipyresis and Fever,
Barbara Styrt, MD, Barrett Sugarman MD.
Arch Intern Med – Vol 150, August 1990,

(Archives of Internal Medicine is a peer reviewed paper)
Page 1589:

“Antipyretic drugs are effective in diminishing fever, but they have significant side effects and may suppress signs of ongoing infection.”

“Antipyretic therapy should not be instituted routinely for every febrile episode but should be based on evaluation of relative risks in the individual case and reassessed if anticipated benefits are not achieved.”

and

Pg 1594: “The decision to administer antipyretics is frequently made without a documented rational. Current understanding of the mechanisms and pathogenesis of fever suggests that the febrile process has a role in host defense and that routine antipyretic therapy for fever is generally unnecessary and conceivably harmful. “

“Decisions to attempt suppression of fever should be based in infrequent indications arising in an individual case and should take into account the potential risks of antipyresis as well as its often questionable benefits.”

Pg 1594: “In the vast majority of febrile illnesses, there is no evidence that fever is detrimental or that antipyretic therapy offers any significant benefit. Indeed, the limited information available on in vitro immune functions and in vivo outcomes would suggest that fever usually does more good than harm.”

and

“In treating fever “symptomatically” one should not lose sight of the fact that elevated temperatures, whatever their physiologic function, do serve as a signal both to the patient and to the caregiver. Nonspecific suppression of fever may deprive one of clues to a need for further diagnostic investigation, or for changes in therapy. Although these clues will often occur in the context of antipyretic use, one study has indicated that patients with a variety of bacterial infections receiving antipyretics experience a significant delay in institution of needed antibiotic changes.”

Reviews of Infectious Diseases 1991; 13: 462 – 472
Impact of Temperature Elevation on Immunologic Defenses.
Norbert J. Roberts.

Page 469: “Overall, it appears that temperature elevation within the physiologic range most effectively enhances the processes involved in initial antigen recognition and support for immunologically specific response to challenge.”

Pg 470: “Accumulated direct and indirect evidence suggests an overall beneficial effect of physiologic temperature elevation or fever on host defense mechanisms.”

The American Journal of Medicine, volume 88, January 1990,
Antipyretic Orders in a University Hospital
Stuart N. Isaacs MD et al.

Drug used: acetaminophen.

Page 31: “antipyretics are among the most widely used pharmacologic agents. Traditional rationales for their use include relief of discomfort associated with fever, prevention of febrile seizures, avoidance of the high metabolic costs of fever in those who are malnourished or who have cardiac or pulmonary disease, and lessening of brain edema in central nervous system disease or trauma. However, accumulating evidence indicates that fever may be an important defense mechanism.”

“Conclusions: Antipyretic orders are routine and correlate more strongly with hospital service than with individual patient characteristics. They are imprecisely written and generally leave decisions about antipyretic administration to the complete discretion of the nursing staff.”

J. Paediatr. Child health (1993) 29; 84 –85:
Paracetamol: When, why and how much.
Editorial

“in patients without heart and lung disease fever is harmful only at temperatures over 41 o C; such high termperatures are usually caused by heat stroke or brain injury, and they do not respond to paracetamol or aspirin.”

“There is no evidence that antipyretics prevent febrile convulsions”

Acta Paediatr Jpn 1994 Aug; 36(4) 375 – 378.
Risks of antipyretics in young children with fever due to infectious disease.
Sugimura T, et al.

“The objective of this study was to determine whether paracetamol (acetaminophen) affects the outcome of children with fever due to bacterial infectious disease….. the data suggest that frequent administration of antipyretics to children with infectious disease may lead to a worsening of their illness.”

Infect Dis Clin Corth Am 1996, March; 10(1) : 211 – 216
Treatment of Fever
Klein NC, et al.

“Fever is an important indicator of disease and should not be routinely suppressed by antipyretics. There is considerable evidence that fever may actually benefit the host defense mechanism. … Routine antipyretic therapy should be avoided but may be necessary in individual patients with underlying cardiovascular or neurologic disorders.

Eur J. Pediatr 1994, June; 153 (6) 394 – 402
Treatment of fever in childhood.
Adam D, et al.

“Not all fevers need to be treated, but many physicians do so to relieve parental concern.

Eur J. Pediatr 1994, June; 153 (6) 394 – 402
Treatment of fever in childhood.
Adam D, et al

“The most commonly used antipyretic drugs are acetylsalicylic acid (ASA) paracetamol (acetaminophen) and dipyrone (metamizol). …Paracetamol is the most common cause of acute hepatic failure… in the light of these findings, the extensive use of antipyretics drugs has been seriously questioned.”

“Page 398: “Paracetamol has a pronounced liver toxicity. In the United Kingdom paracetamol is considered to be responsible for more cases of acute hepatic failure than any other cause.”

Page 399 “the potential for toxicity of ASA and paracetamol, the two most extensively used antipyretics in the febrile child, underlines the constraints within which treatment decisions have to be made. The fact that both drugs are sold as “over the counter” products, while the medication of child fever often occurs without medical control, should be a matter of concern.

http://www.ntmedic.com.au/Front%20Pa...0Chronicle.htm

Paracetamol
Since the toxic level of paracetamol is not much greater than its therapeutic level patients must be cautioned not to exceed the recommended dose. They should be warned that cold remedies may contain paracetamol and/or aspirin, and inadvertent overdose is possible.

The Journal of Pediatrics February 1997, volume 130 Number 2
Outcome of acetaminophen overdose in pediatric patients and factors contributing to hepatotoxicity.
Teresa Rivera-Panera MD. Et al

Page 302: “concomitant viral infections, metabolic problems or fasting can potentially aggravate hepatic toxic effects. The majority of patients who ingested multiple overdoses had fever as an indication for taking the antipyretic agent and thus may have been harboring an underlying condition.”

The Journal of Pediatrics January 1998, Volume 132, Number 1,
Therapeutic misadventures with acetaminophen: Hepatotoxicity after multiple doses in children.
James E. Heubit, MD, et al.

Page 26: “In most multiple accidental overdoses, infants and children are febrile and acutely malnourished…. Concern may be raised because several subjects received reported doses that w4re only slightly above the recommended doses… If the reported doses are accurate, our findings suggest that the therapeutic index for acetaminophen may be 1 to 1.7 when an ill, febrile child received acetaminophen. In addition, Alonso et al suggest that even therapeutic doses of acetaminophen may lead to centrilobular necrosis in the susceptible child.”

[Mirzam]

Thank you so very much!

[Momtezuma Tuatara]

Well, its not pretty reading, but you're welcome.

[spero]

MT, you rock.

This is great info. I am always hesitant to "treat" a fever in my kids....and one time, the PA (whom I haven't ever liked) at our ped's office gave me holy freakin' hell for allowing my DS's fever to run its course.

While DH was in critical care for his accident, he ran a fever for a couple of weeks. I seemed to be the only one who wasn't terribly concerned.

[Mirzam]

MT, is there any evidence that antipyretics actually prolong inflammation and therefore the fever?

Ta!

[Momtezuma Tuatara]

In general, the evidence so far is that antipyretics appear to prolong illness by reducing the temperature, thereby disabling the body's full ability to deal with whatever is the problem.

The general principle IME with unmedicated children has been that the lower the temperature, the longer the duration. The higher the temperature, the shorter the duration. Immunologically, it seems that temperatures from infection are specifically designed to ramp UP the immune system, release cytokines and other immunological "forces" to deal with the problem.

Call it a metabolic bonfire if you wish. Obviously, the greater the blaze, the quicker it is that the fire runs out of "fuel". As a crude analogy, that seems to be what happens in the body.

So the reverse proof is there, mainly seen in older research such as below:

J. Infect Dis 1970; 121: 81 – 86
Is suppression of fever or hypothermia useful in experimental and clinical infectious diseases?
Klastersky J, et al.

Result: (antipyretic) adverse effects on host defense have modified early interest in their use as antipyretics per se…

They don't give a definitive answer, but you sense more than just a backtracking...


Am J Med Sci, 1980: 280; 73 – 80, Polymicrobial sepsis: an analysis of 184 cases using log linear models.
Mackowiak P A et al.

Result: An increase of mortality with absence of fever in polymicrobial sepsis


Arch Intern Med. 1971: 127: 120 – 128. Factors affecting mortality of Gram negative rod bacteremia,
Bryant R. E et al. AND…

Am J. Med, 1980; 68: 344 – 355. Gram-negative bacteremia IV: re-evaluation of clinical features and treatment in 612 patients.
Kreger, B. E. et al.

Result. An increase of mortality with absence of fever in gram-negative bacteremia.


N Y State J Med. 1971; 71: 2747 – 2754.
Prnumococcal meningitis at Harlem hospital.

Richter R W et al.

Result: An increase of mortality with absence of fever in pneumococcal meningitis.







The American Journal of Medicine, volume 88, January 1990,
Antipyretic Orders in a University Hospital
Stuart N. Isaacs MD et al.

Page 34: “Fever is a potentially beneficial physiologic response to infection. Experimentally induced fever has been shown to augment certain aspects of inflammation, the immune response, and antibiotic activity. Additionally, fever inhibits growth of pathogenic bacteria and enhances survival in animals with bacterial infection. Few data are available concerning the effect of fever on the outcome of human infections. Retrospective analyses have supported a correlation between fever and an increased rate of survival in several studies of severe bacterial infections in humans, but it is unclear whether fever was a cause or an effect of enhanced host defence.

Implication here, is that antipyretic treatment prolongs the duration, and by actively down regulating the immune system, seems to allow the bacteria a greater "hold" thereby increasing the severity and duration of the illness, therefore, as the WHO says above, the possible morbidity as well.

which ties in with the quote above:

Aust Prescr 1995; 18: 233- 234.
Paracetamol: use in children.
Frank Shann, Intensive care Unit, Royal Children’s Hospital, Melbourne.

“Paracetamol may prolong infection and reduce the antibody response in mild disease, and increase morbidity and mortality in severe infection.”

also

http://www.scielosp.org/scielo.php?s...lng=en&nrm=iso

“In summary, what does the evidence seem to indicate? Fever represents a universal, ancient, and usually beneficial response to infection, and its suppression under most circumstances has few, if any, demonstrable benefits. On the other hand, some harmful effects have been shown to occur as a result of suppressing fever: in most individuals, these are slight, but when translated to millions of people, they may result in an increase in morbidity and perhaps the occurrence of occasional mortality. It is clear, therefore, that widespread use of antipyretics should not be encouraged either in developing countries or in industrial societies.”

a bit of an understatement, but you expect that from WHO.


(Pediatr Vol 103, No 4, April 1999, 783-784 and 785-790. Infect Med 1999 16 (5):307 :

Both show that Chickenpox treated antipyretically with Tylenol/Ibuprofen provokes bacterial skin infections into fulminant necrotising fasciitis.

This can only happen by prolonging inflammation and downregulating the immune system, so that it can no longer activate fully the adaptive arm of immunity as well.

Infect Dis Clin North Am 1996 Mar;10(1) : 1-20

"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..."

Pharmacotherapy December 2000; 20: 417 – 422;

http://id.medscape.com/reuters/prof/...01clin003.html

As reported on internet, by “Health Scout” and Reuters medical News for the professional:

Findings. Those with influenza A who took antipyretics were sick much longer than their flu-infected counterparts who took nothing.

Health Scout : Quoting Dr Leland Rickman, Associate clinical professor of medicine, University of California:

“an elevated temperature may actually help the body fight the infection quicker or better than if you don’t have a fever.”

Quoting Dr Karen Plaisance, Associate Professor at the University of Maryland School of Pharmacy and one of the study’s authors “Influenza A sufferers who were treated with aspirin or acetaminophen extended their illness from five days to about 8 ½ days.”

As stated ion the Acta Pediatr Jpn ref above,

“The objective of this study was to determine whether paracetamol (acetaminophen) affects the outcome of children with fever due to bacterial infectious disease….. the data suggest that frequent administration of antipyretics to children with infectious disease may lead to a worsening of their illness.”

While no one medical article can be "definitive" on its own, a broad picture emerges which biochemically appears fairly straightforward really.

[Momtezuma Tuatara]

In looking at what anti-pyretics might do to the immune system, it also helps to consider this:


http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

The authors recently observed that frequent paracetamol use was positively associated with asthma and rhinitis in young adults. ….Their associations with national 1994/1995 per capita paracetamol sales were measured using linear regression. Paracetamol sales were high in English-speaking countries, and were positively associated with asthma symptoms, eczema and allergic rhinoconjunctivitis in 13-14-yr-olds, and with wheeze, diagnosed asthma, rhinitis and bronchial responsiveness in adults. The prevalence of wheeze increased by 0.52% in 13-14-yr-olds and by 0.26% in adults (p<0.0005) for each gram increase in per capita paracetamol sales. These ecological findings require cautious interpretation, but raise the possibility that variation in paracetamol usage may explain some of the variation in atopic disease prevalence between countries.

and

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11826230

Asthma morbidity after the short-term use of ibuprofen in children.

“However, the risk of an outpatient visit for asthma was significantly lower in the ibuprofen group; compared with children who were randomized to acetaminophen, the relative risk for children who were assigned to ibuprofen was 0.56 (95% confidence interval: 0.34-0.95). CONCLUSIONS: Rather than supporting the hypothesis that ibuprofen increases asthma morbidity among children who are not known to be sensitive to aspirin or other nonsteroidal antiinflammatory drugs, these data suggest that compared with acetaminophen, ibuprofen may reduce such risks. Whether the observed difference in morbidity according to treatment group is attributable to increased risk after acetaminophen use or a decrease after ibuprofen cannot be determined.”

[Mirzam]

Wow, thank you so much. I have a lot to read and digest!

[suschi]

In a nutshell ( from info included in How To Raise A Healthy Child in Spite of Your Doctor, by Dr Robert S Mendelsohn) and info from medical sites and from the articles posted from Hilary....

When one has a fever, production of the pac man like cells that chomp away at infection is increased, when the fever is reduced, you lower the production of these cells. So to lower a fever would be counterproductive.

The body has a built in theromstat that prevents the fever from getting too high, unless fever is caused by poisoning, via sun or chemical, meaning in most cases, a fever cannot get "too high".

Only cases of fever that warrant a real concern, in those with history of febrile seizures or those mention above, by way of poisoning.

A fever is NOT a good indication of seriousness of infection, meaning a mild infection can have a very high fever, and a serious infection can have a very low fever.

Luckily, I read Mendelsohn's book the year it was released, the same year my first baby was born, 1984. The main parts that stuck with me,

~don't interfere with a fever (in most cases)

~don't give antibiotics (in most cases)

Dr Mendelsohn explained how the antibiotics destroy all bacteria, good and bad, causing other problems, including not letting the body compose it's own to fight the infection, meaning next time the same germ comes along, the body has not built up it's own defense...had it been left to it's own, the 2nd infection would have probably been effectively fought off. He explains this may be the reason for repeated ear infections that are treated with antibiotics. My five children received little to no fever reducers while growing up. My youngest, born 9/02, is unvaccinated and he has not had any medication at all to date.

[Periwinkle]

I just did a search of MDC using Hilary and Acetaminophen as search terms looking for that awesome thread I read a year or two ago (?) on exactly this issue, and didn't get anything. : I know Hillary isn't here anymore but why did her posts go away? OMG I feel like I arrived to Times Square at 12:01am. What a bummer it's not on MDC anymore! :

Anyway, bumping since it's cold/flu etc. season again.

:

[CallMeMommy]

I'm so glad you brought this up right now. My baby is upstairs sleeping off a mild fever WITHOUT Tylenol. The mainstreamer in my keeps saying "what if the fever goes higher and he has a seizure or overheats", but thanks to this post coming at just the right time I know I am NOT going to go up there and give him any medicine!

[dallaschildren]

[Periwinkle]

[DevaMajka]

In MT's post:

It should be explained to parents that fever is usually a helpful response to infection, and that paracetamol should be used to reduce discomfort, but not to treat fever.

How do you all feel about Tylenol to reduce discomfort? Ds has been sick (cold, and ear infection), and is getting better. I didn't give him the antibiotics because his ear wasn't bothering him. I did give him one dose of Tylenol once because he was waking up crying from a sore throat. He slep really well after that.
What are the opinions on that? I just couldn't stand to let him hurt that much, kwim?
Is tylenol a complete no-no?

[dallaschildren]

Originally Posted by Deva33mommy

In MT's post:

How do you all feel about Tylenol to reduce discomfort?

From one of the links provided if this helps:

http://www.australianprescriber.com/...aracetamol.htm

"It should be explained to parents that fever is usually a helpful response to infection, and that paracetamol should be used to reduce discomfort, but not to treat fever."

And

Discomfort
It is sensible to give paracetamol to reduce the unpleasant symptoms caused by mild acute infections. However, paracetamol does not have a dramatic effect: a recent controlled trial5 found that paracetamol caused only a modest improvement in activity and alertness in children with acute infection, and that there was no significant improvement in mood, comfort, appet ite or fluid intake. Because many patients with infection have fever and discomfort, it is often assumed that fever causes discomfort but strenuous exercise causes temperatures up to 40oC without causing discomfort.

DC

[Sherra]

hey Becky,

See what you think of this thread:

http://www.mothering.com/discussions...ghlight=motrin

I love the thread above, it really got me to thinking about more natural means to help with comfort. I liked the herbal remedy route and when I get time, I wish to read more on it. Some folks posted what they used and found effective. Might help you out!

[Momtezuma Tuatara]

Deva33Mommy

I was going to say I had no problems with you giving yourself tylenol to reduce your discomfort about your son's cold . But having respect for your liver, I withdraw such an inane statement.