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Letter to the editor

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
Thirza Titchen
Deputy Director of Pharmacy
Royal Children's Hospital
Melbourne


References

  1. Walson PD, Galletta G, Chomilo F, Braden NJ, Sawyer LA, Scheinbaum ML. Comparison of multi dose ibuprofen and acetaminophen therapy in febrile children. Arch Pediatr Adolesc Med 1992;146:626-32.
  2. McCullough HN. Acetaminophen and ibuprofen in the management of fever and mild to moderate pain in children. Paediatr Child Health 1998;3:246-51.
  3. Mayoral CE, Marino RV, Rosenfeld W, Greensher J. Alternating antipyretics: is this an alternative? Pediatrics 2000;105:1009-12.
  4. Lesko SM, O'Brien KL, Schwartz B, Vezina R, Mitchell AA. Invasive group A streptococcal infection and nonsteroidal anti-inflammatory drug use among children with primary varicella. Pediatrics 2001;107:1108-15.