Efficacy and Safety of Acetaminophen vs Ibuprofen for Treating Children’s Pain or Fever

Objective: To summarize studies testing the efficacy and safety of single-dose acetaminophen and ibuprofen for treating children’s pain or fever.
Data Sources  Reports were gathered by searching computerized databases (from their inception through May 2002) and registries, relevant journals, and bibliographies of key articles.
Study Selection  Seventeen blinded, randomized controlled trials with children (<18 years) receiving either drug to treat fever or moderate to severe pain.
Data Extraction  Under a fixed-effects model, outcome measures for an initial single dose of ibuprofen vs acetaminophen were the risk ratio for achieving more than 50% of maximum pain relief, effect size for febrile temperature reduction, and risk ratio for minor and major harm.
Conclusions:  In children, single doses of ibuprofen (4-10 mg/kg) and acetaminophen (7-15 mg/kg) have similar efficacy for relieving moderate to severe pain, and similar safety as analgesics or antipyretics. Ibuprofen (5-10 mg/kg) was a more effective antipyretic than acetaminophen (10-15 mg/kg) at 2, 4, and 6 hours posttreatment.
(Arch Pediatr Adolesc Med. 2004;158:521-526.)

Cough Syrups Are Not Superior to Placebo!
Diphenhydramine and dextromethorphan are not superior to placebo in providing nocturnal symptom relief for children with cough and sleep difficulty as a result of an upper respiratory infection. Furthermore, the medications given to children do not result in improved quality of sleep for their parents when compared with placebo. Each clinician should consider these findings, the potential for adverse effects, and the individual and cumulative costs of the drugs before recommending them to families.
(PEDIATRICS Vol. 114 No. 1 July 2004, pp. e85-e90)
Extended-Interval Aminoglycoside for
Children: A Meta-analysis
There has been a long-standing debate regarding whether aminoglycosides should be administered on a multiple daily dosing (MDD) or once-daily dosing (ODD) schedule. Several unique characteristics of the aminoglycosides make ODD an attractive and possibly superior alternative to MDD. These include concentration-dependent bactericidal activity; postantibiotic effect, which allows continued efficacy even when serum concentrations fall below expected minimum inhibitory concentrations; decreased risk of adaptive resistance; and diminished accumulation in renal tubules and inner ear.
Results:
Efficacy: There was no significant difference between ODD and MDD in the clinical failure rate, microbiologic failure rate, and combined clinical or microbiologic failure rates, but trends favored ODD consistently. There was no between-study heterogeneity for any outcome. Efficacy analysis of all trials indicating either clinical or microbiologic failures demonstrated pooled failure rates of 4.6% (23 of 501 cases) in the ODD arms and 6.9% (34 of 494 cases) in the MDD arms.
Nephrotoxicity: There was no significant difference between ODD and MDD in the primary nephrotoxicity outcomes. Secondary nephrotoxicity outcomes were significantly better with ODD.
Ototoxicity: There was no significant difference between ODD and MDD in the primary ototoxicity outcomes.
Data Interpretation. Clinical failures were uncommon in the pediatric trials, regardless of the regimen used. If anything, fewer clinical failures tended to occur with ODD. Moreover, we observed a trend toward decreased bacteriologic failures.
Conclusions. Although single trials have been small, the available randomized evidence supports the general adoption of ODD of aminoglycosides in pediatric clinical practice. This approach minimizes cost, simplifies administration, and provides similar or even potentially improved efficacy and safety, compared with MDD of these drugs.
(PEDIATRICS Vol. 114 No. 1 July 2004, pp. e111-e118)

Early Infant Multivitamin Supplementation Is Associated With Increased Risk for Food Allergy and Asthma
Dietary vitamins have potent immunomodulating effects in vitro. Individual vitamins have been shown to skew T cells toward either T-helper 1 or T-helper 2 phenotypic classes, suggesting that they may participate in inflammatory or allergic disease. With the exception of antioxidant protection, there has been little study on the effect of early vitamin supplementation on the subsequent risk for asthma and allergic disease. The objective of this study was to determine whether early vitamin supplementation during infancy affects the risk for asthma and allergic disease during early childhood.
The researchers in above study concluded that early vitamin supplementation is associated with increased risk for asthma in black children and food allergies in exclusively formula-fed children. Additional study is warranted to examine which components most strongly contribute to this risk. (PEDIATRICS Vol. 114 No. 1 July 2004, pp. 27-32)

Combination Tx for Asthma Effective in Single Daily Dose
A single daily dose of fluticasone propionate/salmeterol was safe and effective in asthma control, Dr. Paul Dorinsky reported in a poster session during the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
The combination of fluticasone and salmeterol (250 micro g/50 micro g) was significantly better than placebo or fluticasone alone in several measures, including the change in predicted peak expiratory flow, the change in asthma symptom scores, and the change in albuterol use, reported Dr. Dorinsky of GlaxoSmithKine (Research Triangle Park, N.C.).
Fluticasone/salmeterol (Advair Diskus) is approved for twice-daily use, but the combination’s pharmacokinetic properties and previous clinical studies suggest that once-daily dosing may be possible. The more convenient dosing regimen may facilitate improved patient compliance.
The investigators reported the results of a large, double-blind, placebo-controlled, parallel-group trial on patients with asthma who required pharmacotherapy. The 632 patients, aged 12 years or older, had suffered from asthma for a mean of 19 years.
The patients administered a single dose of fluticasone/salmeterol, fluticasone (250 ìg) alone, or placebo once a day in the evening for 12 weeks.
Patients on fluticasone/salmeterol had a significantly greater improvement in percent predicted a.m. and p.m. peak expiratory flow (PEF) than did patients on fluticasone alone or placebo. Over the course of the study, patients on the combination had a 2.8% advantage in p.m. PEF over those on fluticasone and a 5.1% advantage over those on placebo. The corresponding figures for a.m. PEF were 4.4% and 8.5%. All of those differences were statistically significant. In both PEF measures, fluticasone alone was significantly better than placebo.
Compared with baseline, patients on fluticasone/salmeterol used albuterol about 1.8 fewer times per day on average during the trial. Patients on fluticasone alone used their albuterol about 1.4 fewer times per day, and patients on placebo used their albuterol about 0.4 fewer times per day. Fluticasone/salmeterol and fluticasone alone were both significantly better than placebo on this measure, and fluticasone/salmeterol was also better than fluticasone alone.
The investigators observed the same pattern when comparing adjusted 24-hour asthma symptom scores, which were graded on a 0 to 9 scale. Patients taking fluticasone/salmeterol had an improvement of about 1.3 points, compared with a 1-point improvement in those on fluticasone, and a 0.6-point improvement in those on placebo.
All of the treatments were well tolerated with few adverse events, and only 4 patients in the treatment groups withdrew due to an asthma exacerbation, compared with 13 in the placebo group.

Juvenile Recurrent Parotitis:
A New Method of Diagnosis and Treatment
Objective. Juvenile recurrent parotitis (JRP) is a nonobstructive, nonsuppurative parotid inflammation in young children. Causative factors, such as local autoimmune manifestation, allergy, infection, and genetic inheritance, have been suggested, but none of them has been proved to date. Until now, treatment of JRP was divided into conservative observation and antibiotic treatment, and no preventive therapy was available.
Methods. Twenty-six cases symptomatic JRP in children were diagnosed and treated with a combined endoscopic approach. Sialography and sialoendoscopy were performed bilaterally in all children. The treatment modality was composed of lavage, ductal dilation, and hydrocortisone injection.
Results. Sialography showed multiple sialectasis in the affected gland and in the contralateral one as well. Dilations and strictures were noticed in the main duct, and kinks could be identified in 31% of the glands. The main endoscopic finding was a white appearance of the ductal layer without the healthy blood vessel coverage. Recurrence of the symptoms occurred in only 2 (8%) children.
Conclusions. The endoscopic technique provides the possibility of a correct diagnosis and treatment. In this article, the researchers present a new treatment modality of irrigation and dilation under direct vision by endoscopically guided miniature surgical instruments.(PEDIATRICS Vol. 114 No. 1 July 2004, pp. 9-12)

The Probiotic Effect of Saccharomyces boulardii in a Pediatric Age Group
The aim of this study was to determine the efficacy of S. boulardii in diarrhea associated with commonly used antibiotics such as sulbactam-ampicillin (SAM) and azithromycin (AZT). Four hundred and sixtysix patients were assigned to four different groups as follows: group 1: 117 patients receiving SAM alone; group 2: 117 patients receiving SAM and S. boulardii; group 3: 105 patients receiving AZT alone; group 4: 127 patients receiving AZT and S. boulardii. Antibiotic-associated diarrhea was seen in 42 of the 222 patients (18.9 per cent) receiving an antibiotic without the probiotic, and in 14 of the 244 patients (5.7 per cent) who received both the probiotic and the antibiotic (p < 0.05). In the group receiving SAM where S. boulardii use was found to be significant, the use of S. boulardii decreased the diarrhea rate from 32.3 to 11.4 per cent in the 1-5 years age group (p < 0.05). This is a pioneering study investigating combined antibiotic and probiotic use in pediatric diarrhea patients.
(From Jr of Tropical Pediatrics, Volume 50, Issue 4, August 2004: pp. 234-238 )
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