Ipecac—going, going, gone!

▸ Ipecac has long been the cornerstone of treatment for childhood poisoning. When administered at home, it was thought to reduce emergency department (ED) use and to improve health outcomes. Using data from 64 poison control centers that serve most of the U.S. population, researchers assessed how home ipecac use correlated with rate of referral to EDs and with outcomes in more than 700,000 young children (age, <6 years) who unintentionally ingested pharmacologic agents.

Only 1.8% of children were given ipecac at home. Overall, 9% were referred to EDs. No relation was observed between home use of ipecac and ED referral. The researchers classified the centers as belonging to one of two groups: those with high rates of recommending home use of ipecac and those with low rates. Both groups had similar rates of ED referral and adverse outcomes.

Comment

▸ Although ipecac use has declined during the past decade, these findings suggest that the clinical care of poisoned children has not been compromised. In a statement published simultaneously with this report, the American Academy of Pediatrics reiterates that prevention strategies are critical. These include posting the universal poison control center number (800-222-1222) in homes and keeping poisons out of children’s sight and reach. The AAP recommends that syrup of ipecac no longer be used routinely as poison treatment in the home and that clinicians advise parents to discard any ipecac they have in the house -- fundamental changes in our approach to the treatment of poisoning in children.

Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 24, 2003

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