Did anyone save that wonderful post she wrote, or does anyone know if she has an article on the subject posted anywhere?
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Originally Posted by Sasha_girl http://www.*********/a/west8.html Hope this helps. |
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. |
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? |
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 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." |
"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." |
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." |
"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." |
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." |
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." |
"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" |
"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." |
"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. |
"Not all fevers need to be treated, but many physicians do so to relieve parental concern. |
"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. |
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. |
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." |
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." |
Result: (antipyretic) adverse effects on host defense have modified early interest in their use as antipyretics per se… |
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. |
"Paracetamol may prolong infection and reduce the antibody response in mild disease, and increase morbidity and mortality in severe infection." |
"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." |
"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..." |
"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." |
"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." |
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. |
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." |
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. |
Originally Posted by Deva33mommy In MT's post: How do you all feel about Tylenol to reduce discomfort? |
Originally Posted by rareimer just a thought, and i'm sure this has been covered before somewhere...but what implications does this have when They tell you to give your baby acetaminophen before or after a vaccination? if it screws up the immune response that way, whether you are giving it for reducing the fever or the discomfort from the vax, it can't be good news. |
Originally Posted by rareimer just a thought, and i'm sure this has been covered before somewhere...but what implications does this have when They tell you to give your baby acetaminophen before or after a vaccination? if it screws up the immune response that way, whether you are giving it for reducing the fever or the discomfort from the vax, it can't be good news. |