Letters to the Editor
- Dr Sean Beggs, Associate Professor Noel Cranswick, Thirza Titchen
- Aust Prescr 2004;27:55-7
- 1 June 2004
- DOI: 10.18773/austprescr.2004.051
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Editor, – Over the past five years the use of ibuprofen to treat fever in children has increased dramatically at the Royal Children's Hospital, Melbourne. This is demonstrated by a seven-fold increase in the purchases of ibuprofen packs/year from 1999 to 2003 (Fig.1). Paracetamol usage and purchase has remained essentially unchanged over the same period, and there has been no significant change in the number or type of patients seen at our hospital. This continually increasing shift in practice has occurred despite the fact that there has been no change in hospital policy on the use of non-steroidal anti-inflammatory drugs. Furthermore, a monthly audit of ibuprofen use on our general paediatric ward showed that 36 of 38 prescriptions for ibuprofen also included paracetamol.
This change in practice may be a combination of three factors. Number one being aggressive marketing of ibuprofen by the drug company, second the change of ibuprofen syrup from Schedule 4 to Schedule 2 in 1998, and finally an increase in the number of British-trained doctors working in our institution. Ibuprofen is far more commonly used in Britain than Australia.
This therapeutic drift is occurring despite a lack of evidence to support it. Paracetamol has been used far more extensively worldwide than ibuprofen, so much so that the risks associated with the use of paracetamol are well known. The same cannot be said for ibuprofen use in children. Ibuprofen has no demonstrated advantages over paracetamol for the treatment of fever, nor has the combined use of these drugs been shown to be of benefit. In fact the combination may lead to an increased incidence of serious adverse effects and confusion regarding their correct dosing.1,2,3,4
Dr Sean Beggs
Senior Fellow, Clinical Pharmacology
Associate Professor Noel Cranswick
Director, Clinical Pharmacology
Deputy Director of Pharmacy
Royal Children's Hospital
Senior Fellow, Clinical Pharmacology , Royal Children's Hospital Melbourne
Director, Clinical Pharmacology , Royal Children's Hospital Melbourne
Deputy Director of Pharmacy , Royal Children's Hospital Melbourne