Safety Issues of Pharmacological Acute Pain Treatment in Children

Rodieux, Frédérique; Piguet, Valérie; Desmeules, Jules Alexandre; Samer, Caroline Flora

doi:10.1002/cpt.1358

Cited by 7 publications

(12 citation statements)

References 95 publications

(167 reference statements)

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“…Infants aged younger than 1 year were more likely to receive an inaccurate dose than older children because caregivers who used inaccurate doses had difficulty in dosing based on their children’s weight [ 11 ]. Overdose of ACE is one of the leading causes of acute liver failure in Western countries [ 10 ]. In addition, elevated liver transaminases have been described even at recommended doses in children as well as adults [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, drug misdose or overdose is an important public health issue, especially with antipyretics because most antipyretics are administered to children. Misdosing of antipyretics has been reported in approximately 50% of ACE and 25% of IBU administrations [8][9][10]; among these, 8.4% to 14% and 9.6% to 14% of patients received higher doses, respectively. Infants aged younger than 1 year were more likely to receive an inaccurate dose than older children because caregivers who used inaccurate doses had difficulty in dosing based on their children's weight [11].…”

Section: Introductionmentioning

confidence: 99%

“…Several randomized controlled trials that have incorporated combination antipyretics have compared the antipyretic effect and toxicity; these studies favored combination therapy for achieving and sustaining an afebrile state [5,10,[13][14][15]. However, the trial limitations included relatively small numbers of patients and a lack of continuously tracked temperatures, especially in the home setting where combination therapy was administered.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Analysis of Single and Combined Antipyretics Using Patient-Generated Health Data: Retrospective Observational Study

Park¹,

Kim²,

Park³

et al. 2021

JMIR Mhealth Uhealth

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Background Fever is one of the most common symptoms in children and is the physiological response of the human immune system to external pathogens. However, effectiveness studies of single and combined antipyretic therapy are relatively few due to lack of data. In this study, we used large-scale patient-generated health data from mobile apps to compare antipyretic affects between single and combination antipyretics. Objective We aimed to establish combination patterns of antipyretics and compare antipyretic affects between single and combination antipyretics using large-scale patient-generated health data from mobile apps. Methods This study was conducted using medical records of feverish children from July 2015 to June 2017 using the Fever Coach mobile app. In total, 3,584,748 temperature records and 1,076,002 antipyretic records of 104,337 children were analyzed. Antipyretic efficacy was measured by the mean difference in the area under the temperature change curve from baseline for 6 hours, 8 hours, 10 hours, and 12 hours after antipyretic administration in children with a body temperature of ≥38.0 ℃ between single and combination groups. Results The single antipyretic and combination groups comprised 152,017 and 54,842 cases, respectively. Acetaminophen was the most commonly used single agent (60,929/152,017, 40.08%), and acetaminophen plus dexibuprofen was the most common combination (28,065/54,842, 51.17%). We observed inappropriate use, including triple combination (1205/206,859, 0.58%) and use under 38 ℃ (11,361/206,859, 5.50%). Combination antipyretic use increased with temperature; 23.82% (33,379/140,160) of cases were given a combination treatment when 38 ℃ ≤ temperature < 39 ℃, while 41.40% (1517/3664) were given a combination treatment when 40 ℃ ≤ temperature. The absolute value of the area under the curve at each hour was significantly higher in the single group than in the combination group; this trend was consistently observed, regardless of the type of antipyretics. In particular, the delta fever during the first 6 hours between the two groups showed the highest difference. The combination showed the lowest delta fever among all cases. Conclusions Antipyretics combination patterns were analyzed using large-scale data. Approximately 75% of febrile cases used single antipyretics, mostly acetaminophen, but combination usage became more frequent as temperature increased. However, combination antipyretics did not show definite advantages over single antipyretics in defervescence, regardless of the combination. Single antipyretics are effective in reducing fever and relieving discomfort in febrile children.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative Analysis of Single and Combined Antipyretics Using Patient-Generated Health Data: Retrospective Observational Study

Park¹,

Kim²,

Park³

et al. 2021

JMIR Mhealth Uhealth

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“…Poisoning incidence peaks at 2–3 years of age, 14 due to increasing mobility and exploratory behaviour. Paediatric opioid exposures are of particular concern, due to children's increased sensitivity to sedation and respiratory depression at low doses 15 . Opioids are the most common drug class involved in poisoning deaths in Australian children 16 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

Opioid exposures in children under 5 years of age (2004–2019): A retrospective study of calls to Australia's largest poisons information centre

Arbaeen

Wheate

Cairns

2021

J Paediatrics Child Health

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Aim To describe time trends in opioid exposures in children under 5 years, and to describe patient demographics, the medicines involved, the reasons for exposure and disposition. Methods A retrospective analysis of paediatric (<5 years of age) opioid exposure calls to the New South Wales Poisons Information Centre (NSWPIC, Australia's largest poison centre), 2004–2019. Joinpoint regression analysis was used to examine temporal trends. Results There were 4807 cases of paediatric opioid exposure during the 16 year study period, with an average of 300 exposures per year. Exposures increased, 2004–2007, with an annual percentage change (APC) of 14.6% (95% CI = 4.3 to 26.0%), then decreased, 2007–2016, APC −3.4% (95% CI = −5.3 to −1.3%). A steeper decrease was observed after 2016, APC −14.1% (95% CI = −21.8 to −5.6%). The overall APC was −2.3% (95% CI = −4.7 to 0.2%), 2004–2019. Accidental exposures accounted for 86% of calls (4137). The majority of calls were from family members regarding exposures that happened at home, highlighting the need for safety initiatives. The preparations most frequently involved were paracetamol/opioid combination products (primarily codeine), 53% (2566) and ibuprofen/opioid combinations 14% (650). Twenty‐two percent of cases were referred to a hospital (1062), and a further 15% (719) of calls originated from hospital staff. Conclusion Opioid exposures in young Australian children continue to occur; however, the rate has declined since 2007. Safe storage and parent education initiatives could further reduce the burden of paediatric opioid poisoning in Australia.

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“…Hence, children are at risk for safety issues; indeed, 50% of children reportedly experienced at least one adverse event. In their Review article, Rodieux et al . discuss the challenges and limitations of pain treatment in children and provide an expert opinion.…”

mentioning

confidence: 99%

Challenges in Neuropharmacology

Cascorbi

2019

Clin Pharma and Therapeutics

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Safety Issues of Pharmacological Acute Pain Treatment in Children

Cited by 7 publications

References 95 publications

Comparative Analysis of Single and Combined Antipyretics Using Patient-Generated Health Data: Retrospective Observational Study

Comparative Analysis of Single and Combined Antipyretics Using Patient-Generated Health Data: Retrospective Observational Study

Opioid exposures in children under 5 years of age (2004–2019): A retrospective study of calls to Australia's largest poisons information centre

Challenges in Neuropharmacology

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