E-drug: Mefenamic acid
---------------------------------------------
The discussion on mefenamic acid and its use in children
illustrates an important issue in healthcare. I know that
mefenamic acid is popular in South Africa, for example, and
is widely prescribed for children with fever. This happens
despite the unfavorable risk/benefit ratio of mefenamic acid,
the availability of safer drugs, and the doubts regarding the
use of antipyretics in children with moderate fever.
Doctors prescribe this drug probably because they have seen
its positive effect in their practices, and mothers routinely ask
for mefenamic acid when their children are ill. So much for
"evidence-based" medicine.
If doctors and other health care personnel have not seen adverse
effects in patients using this drug, and the patient (in the case of
children, the parent) does not report any, there does not seem a
need for changing to a "safer" drug. The question of whether the
risk of using the drug is worth the benefit of course remains.
Information gained from the "real-world" situation in doctor's
practices should be given more prominence and be accepted
as "evidence" if recorded in a systematic and reproducible way.
Meta-analysis (of clinical trials) and other techniques used in
the practice of evidence-based medicine, would probably not
give a satisfactory answer to the question of the rationality of the
use of mefenamic acid in children with fever. (The same
argument can of course be used for the use of diclofenac in
children).
I agree, however, that the doubt about its safety should be
sufficient to motivate prescribers to not use it in children.
Samuel Wagner Ph.D.
Research Specialist in Pharmaceutical Economics
PRIME Institute
Room 7-194, College of Pharmacy, Weaver-Densford Hall
University of Minnesota, 308 Harvard Str. S.E.
Minneapolis 55455, MN, USA
Tel. 612 625 4186 Fax 612 625 9931
email: wagne051@gold.tc.umn.edu
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.