Acetaminophen: More harm than good for chickenpox?

Doran, Timothy; Angelis, Catherine De; Baumgardner, R. A.; Mellits, E. David

doi:10.1016/s0022-3476(89)80461-5

Cited by 166 publications

(102 citation statements)

References 7 publications

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“…This study was prompted by an earlier study from the same group showing that unmedicated ferrets with higher fevers shed less influenza virus [35]. The results are consistent with other studies showing that antipyretic treatment increases viral shedding in human volunteers infected with rhinovirus [36] and lengthens the infectious period in children with chickenpox [37]. Moreover, in a study of human volunteers infected with influenza A, the number of antipyretic doses received was positively correlated with the duration of illness [38].…”

Section: Estimating the Effect For Influenzasupporting

confidence: 84%

Population-level effects of suppressing fever

Earn

Andrews

2014

Proc. R. Soc. B.

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Fever is commonly attenuated with antipyretic medication as a means to treat unpleasant symptoms of infectious diseases. We highlight a potentially important negative effect of fever suppression that becomes evident at the population level: reducing fever may increase transmission of associated infections. A higher transmission rate implies that a larger proportion of the population will be infected, so widespread antipyretic drug use is likely to lead to more illness and death than would be expected in a population that was not exposed to antipyretic pharmacotherapies. We assembled the published data available for estimating the magnitudes of these individual effects for seasonal influenza. While the data are incomplete and heterogeneous, they suggest that, overall, fever suppression increases the expected number of influenza cases and deaths in the US: for pandemic influenza with reproduction number R 1:8, the estimated increase is 1% (95% CI: 0.0-2.7%), whereas for seasonal influenza with R 1:2, the estimated increase is 5% (95% CI: 0.2-12.1%).

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Section: Estimating the Effect For Influenzasupporting

confidence: 84%

Population-level effects of suppressing fever

Earn

Andrews

2014

Proc. R. Soc. B.

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“…Fever is an adaptive host response to infection. In a number of different clinical settings treatment of fever results in a prolonged course of illness [85,86]. No study has prospectively addressed the impact of fever control on neurologic injury, infection or outcome in SAH patients [87].…”

Section: Summary Of the Literaturementioning

confidence: 99%

Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference

et al. 2011

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Subarachnoid hemorrhage (SAH) is an acute cerebrovascular event which can have devastating effects on the central nervous system as well as a profound impact on several other organs. SAH patients are routinely admitted to an intensive care unit and are cared for by a multidisciplinary team. A lack of high quality data has led to numerous approaches to management and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of rebleeding, but provide limited discussion of the complex critical care issues involved in the care of SAH patients. The Neurocritical Care Society organized an international, multidisciplinary consensus conference on the critical care management of SAH to address this need. Experts from neurocritical care, neurosurgery, neurology, interventional neuroradiology, and neuroanesthesiology from Europe and North America were recruited based on their publications and expertise. A jury of four experienced neurointensivists was selected for their experience in clinical investigations and development of practice guidelines. Recommendations were developed based on literature review using the GRADE system, discussion integrating the literature with the collective experience of the participants and critical review by an impartial jury. Recommendations were developed using the GRADE system. Emphasis was placed on the principle that recommendations should be based not only on the quality of the data but also tradeoffs and translation into practice. Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data.

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“…15 Data show beneficial effects on certain components of the immune system in fever, and limited data have revealed that fever actually helps the body recover more quickly from viral infections, although the fever may result in discomfort in children. 11,[16][17][18] Evidence is inconclusive as to whether treating with antipyretics, particularly ibuprofen alone or in combination with acetaminophen, increases the risks of complications with certain types of infections. 19,20 Potential benefits of fever reduction include relief of patient discomfort and reduction of insensible water loss, which may decrease the occurrence of dehydration.…”

Section: Physiology Of Fevermentioning

confidence: 99%

Fever and Antipyretic Use in Children

Sullivan¹,

Farrar²

2011

Pediatrics

363

313

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Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a “normal” temperature. Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child's overall comfort rather than focus on the normalization of body temperature. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized. Current evidence suggests that there is no substantial difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever. There is evidence that combining these 2 products is more effective than the use of a single agent alone; however, there are concerns that combined treatment may be more complicated and contribute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices.

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Acetaminophen: More harm than good for chickenpox?

Cited by 166 publications

References 7 publications

Population-level effects of suppressing fever

Population-level effects of suppressing fever

Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference

Fever and Antipyretic Use in Children

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