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ADC Fetal and Neonatal Edition Letters and ADC Education and Practice Letters
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Details on the use of antipyretics?
- John M Feller (13 September 2001)
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Re: Details on the use of antipyretics?
- Hans Erik Nielsen (20 September 2001)
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John M Feller, Consultant Paediatrician Sydney Children's Hospital
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johnfeller{at}bigpond.com John M Feller
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Dear Editor, The article by Nielsen et al.(Arch Dis Child Aug 2001), as well as previous articles and letters of many contributors in earlier editions and elsewhere, in considering "diagnosis" in children presenting with purpuric rash(with or without systemic illness), all fail to report on presence or absence of one particular factor. This is details of use of anti- pyretics, other than paracetamol(acetominaphen), in the period preceding onset of rash. In Australia, where the last two years saw market withdrawal of Paracetamol products after poisoning threats by extortionists, there has been increasing trend towards use of proprietary brands of Ibuprofen, to treat fever. Often the actual systemic symptoms of the causal viral illness may have subsided by the time the purpuric rash of any ensuing side effect of thrombocytopaenia or platelet aggregation dysfunction might manifest. We have had several cases of children, not significantly systemically unwell, presenting this way, where thorough investigation failed to detect any evidence of meningococcal or other bacterial infection, but Ibuprofen had been used in the previous days. Platelet dysfunction is a well-recognised side effect of all COX-1 NSAIDS and enquiry about history of use can be contributory in diagnosis. Finally, a Gram-stain of blood sampled from a single skin purpuric lesion can be a rapid test for true meningococcemia, and can be a valuable diagnostic test.
Dr. John M. Feller MB BS FRACP |
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Hans Erik Nielsen, Consultant Paediatric Department, Gentofte Hospital, DK
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Hanie{at}gentoftehosp.kbhamt.dk Hans Erik Nielsen
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Dear Editor In response to Dr Feller's comment we can inform you: That we have not recorded the use of antipyretics. However, in Denmark, the only drug used for this purpose in children is paracetamol. Ibuprofen and similar NSAIDS are not used. Therefore, a side effect of this group of drugs cannot account for any of the large group of children in whom we found no explanation of the disease. Yours sincerely H.E.Nielsen |
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