E-DRUG: Cough and cold remedies for children (2)
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Dear E-druggers,
Am I the only one who is confused by the advice now being offered? I
quote from the Australian article circulated earlier:
"Children with upper respiratory tract symptoms may benefit from adequate
hydration and rest, together with 'symptomatic relief with analgesia, .. if
required."
What symptomatic relief is now available for use in children, since "cough and cold remedies" as a
whole (poorly defined) class of medication are now restricted?
I suggest there is a problem of definition here - which EXACTLY are the
substances which are allowed, and which EXACTLY are not recommended?
A second concern is whether prescribers will come under additional pressure to prescribe
antibiotics - and what is the balance of harm in that equation?
Take the specific example of a child with flu - of which there are many
here in the US - what is the
best advice that can be offered to that parent? Parents need to know
not only of what NOT to give, but what IS
permissible to give to alleviate symptoms in the screaming child.
--
Susan Foster, PhD
Director of Public Policy and Education
Alliance for the Prudent Use of Antibiotics
75 Kneeland Street, 2nd Floor
Boston, MA 02111
+1 617 636 3961 (phone)
+1 617 636 3999 (fax)
www.apua.org
"Susan Foster (APUA)" <susan.foster@tufts.edu>
E-DRUG: Cough and cold remedies for children (3)
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I think the advice about cough medicines in children is straight forward.
There are range of OTC medicines that claim symptomatic benefit in
cough in children.
Studies have failed to demonstrate significant benefit from these medicines.
Occasional serious ADRs have been reported in children, especially <2yo.
While that are not harmful to the majority of children who use them,
they are of no benefit either.
Note that this relates to cough. It does not cover OTC analgesia.
It is not relevant to a "screaming" child which would require a
different diagnostic approach and treatment.
The recent article in Australian Prescriber summarises this,
including a table of the constituent pharmacological agents involved.
It impossible to list all possible cough medicine preparations
covered by this due to multiple combinations and brands which vary
from country to country.
For further information, you can freely access the article at:
<http://www.australianprescriber.com/magazine/32/5>
Noel E Cranswick
Director, Clinical Pharmacology, Royal Children's Hospital
Director, APPRU, Murdoch Children's Research Institute & the Royal Children's
Hospital
Associate Professor, University of Melbourne
5th Floor, Main Building
Royal Children's Hospital,
Parkville Victoria 3052
Australia
Noel Cranswick <noel@melbpc.org.au>
E-DRUG: Cough and cold remedies for children (4)
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Susan Foster says she is confused about the recent Australian decision to
rescheduled over-the-counter cough and cold remedies for children under two
years to prescription-only and the recommendation that:
"Children with upper respiratory tract symptoms may benefit from adequate
hydration and rest, together with 'symptomatic relief with analgesia, .. if
required."
She asks "which EXACTLY are the substances which are allowed, and which
EXACTLY are not recommended?"
In Australia the word analgesics means acetaminophen (which we Australians
and most other countries call paracetamol), NSAIDs and narcotics and any
other drugs that are primarily used to reduce pain. In this context the main
drug that is used is paracetamol.
The drugs that are not recommended are:
* The antihistamines: brompheniramine maleate, chlorpheniramine maleate and
diphenhydramine hydrochloride;
* The antitussives: dextromethorphan hydrobromide and pholcodine;
* The expectorants: guaifenesin and ipecacuanha; and
* The decongestants: phenylephrine hydrochloride and pseudoephedrine
hydrochloride.
See:
www.tga.gov.au/media/2008/080409cold.htm
Susan also asked "whether prescribers will come under additional pressure to
prescribe antibiotics - and what is the balance of harm in that equation?"
I don't know. I think the risks are reduced by the availability of
paracetamol to meet the need to give a drug but the risks are not zero.
However I think our regulatory agency deserves congratulations for telling
the truth about the cough and cold drugs.
--
regards,
Peter
Dr Peter R Mansfield OAM BMBS
GP
Director, Healthy Skepticism Inc
www.healthyskepticism.org
Visiting Research Fellow, University of Adelaide
www.adelaide.edu.au/directory/peter.mansfield
Peter R Mansfield <peter.mansfield@adelaide.edu.au>
E-DRUG: Cough and cold remedies for children (5)
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The explanation made by Peter Mansfield clarifies the queries from Susan
Foster. Most of the medicines that are not recommended may not have
sufficient evidence for efficacy and safety in the symptomatic relief of
acute respiratory infections in children.
The risk of replacing those medicines with antibiotics can be real,
but it can be minimized with good communication and advice to patients.
Thanks
Budiono Santoso MD, PhD
Regional Advisor in Pharmaceuticals
World Health Organization,
Western Pacific Regional Office,'
Manila, the Philippines
Phone : (632) 5289846
Fax : (632) 5211036
"Santoso, Dr Budiono (WPRO)" <SANTOSOB@wpro.wh