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A 3-year-old is seen in Accident & Emergency with a rash and fever. On examination, there are vesicular lesions consistent with chicken pox. His parents are concerned about his fever and distress despite regular paracetamol, and ask you if they can give ibuprofen as well.
Structured clinical question
In children with varicella (population), does the use of non-steroidal anti-inflammatory drugs (NSAID) (exposure) increase the risk of infectious complications of varicella (outcome)?
Ovid Medline was searched using the search terms (Varicella (mapped to Chicken Pox)) AND (NSAID OR ibuprofen OR non-steroidal anti-inflammatory). The search resulted in 64 articles and all available abstracts were reviewed. Review articles, studies not addressing the question, case studies, letters and articles not published in English were excluded at this point. Ten articles were relevant. On review of the full text, five of these ten articles did not address the clinical question and were excluded, leaving a total of five studies. Each article was appraised using a structured approach (table 1).
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