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Charde V, Sanklecha M, Rajan P, Naeem B, Wanjari M, Mittal G, Adrien TDE. Assessing the safety and adverse effects of paracetamol, ibuprofen, and their combination in paediatric pain and fever management: A prospective observational study. J Family Med Prim Care 2025; 14:680-686. [PMID: 40115566 PMCID: PMC11922349 DOI: 10.4103/jfmpc.jfmpc_348_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/27/2024] [Accepted: 10/09/2024] [Indexed: 03/23/2025] Open
Abstract
Purpose Pain and fever are common paediatric complaints that demand meticulous symptom alleviation to ensure the child's holistic well-being. Paracetamol, ibuprofen, and their synergistic coadministration occupy a crucial position, rendering the management of these symptoms efficacious. This study aims to evaluate the safety and adverse effects of paracetamol, ibuprofen, and their combination comprehensively. Methods A prospective observational study was conducted at the Department of Paediatrics, Bombay Hospital Institute of Medical Sciences, Mumbai, India. 108 paediatric patients aged 6 months to 18 years experiencing fever, pain, or both. Patients were assigned to receive one of the three medications and were randomized into one of the three groups: paracetamol, ibuprofen, or a combination. Baseline and 48-hour assessments included vital signs, adverse effects, and biochemical markers including SGOT, SGPT, serum creatinine, platelet count, and occult blood in stool samples. Results Paracetamol, ibuprofen, and their combination were found to be equally effective in relieving symptoms associated with fever and pain. The most common adverse effect observed was vomiting, with minimal occurrences of rash, cough, and diarrhoea. Biochemical markers, including SGOT, SGPT, serum creatinine, platelet count, and occult blood in stool samples, remained within normal ranges after 48 h of drug administration. Conclusion This study affirms the safety of paracetamol, ibuprofen, and their combination for paediatric pain and fever management. Minimal adverse effects and the absence of significant biochemical derangements support their favourable risk-benefit profiles, emphasizing their importance in paediatric clinical practice.
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Affiliation(s)
- Vivek Charde
- Department of Pediatrics, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Mukesh Sanklecha
- Department of Pediatrics, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Priyank Rajan
- Department of Pediatrics, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Babar Naeem
- Department of Pediatrics, Jinnah Hospital, Lahore, Pakistan
| | - Mayur Wanjari
- Department of Research and Development, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
| | - Gaurav Mittal
- Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Tanjmi Djabo Eric Adrien
- Department of Medicine, Université Technologique Bel Campus, Kinshasa, Democratic Republic of Congo
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Abstract
Drug eruptions in children are common but in general less studied than their adult counterparts. Aside from having significant impact on the child's health and quality of life, these reactions can limit what medications the patient can receive in the future. Familiarity with pediatric drug eruptions is important for accurate diagnosis and to prevent future recurrence or ineffective therapy. Our current understanding of how drug reactions differ mechanistically between children and adults is poor. There are multiple factors that could be contributing to the differing incidence, presentation, and treatment modalities offered to pediatric versus adult patients. For many of these cutaneous drug reactions, the treatment regime is not standardized, being based primarily on case reports. Although not comprehensive, this review highlights common pediatric drug eruption patterns and discuss diagnostic mimickers. Five cutaneous adverse drug reactions in the pediatric population are presented: morbilliform (exanthematous) eruptions, urticarial eruptions, serum sickness-like reactions, fixed drug eruptions, and DRESS syndrome. Clinical features, diagnostic workup, and management are discussed with an emphasis on the pediatric population.
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Affiliation(s)
- EmilyD Nguyen
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Colleen K Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Oberlin KE, Rahnama-Moghadam S, Alomari AK, Haggstrom AN. Drug reaction with eosinophilia and systemic symptoms: Pediatric case series and literature review. Pediatr Dermatol 2019; 36:887-892. [PMID: 31423638 DOI: 10.1111/pde.13949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric Drug reaction with eosinophilia and systemic symptoms (DRESS) is an uncommon disease that can be difficult to diagnose. This case series and literature review highlights the clinical features of pediatric DRESS and underscores the differential diagnoses, culprit medications, and need for clinical follow-up to detect associated autoimmune sequelae. OBJECTIVE To describe the clinical and laboratory features of pediatric DRESS, identify associated culprit medications, and discuss the natural history of disease. METHODS Ten cases of pediatric DRESS were identified in the electronic medical record by searching the inpatient dermatology consultation list at Indiana University between 2013 and 2018. Clinical and laboratory data were collected including demographics, differential diagnoses, culprit medications, resolution of disease, and autoimmune sequelae. RESULTS Pediatric patients with DRESS presented at a mean age of 11.5 years and demonstrated a mean time from drug initiation to onset of symptoms of 4 weeks. The most common inciting drugs included antibiotics (62.5%) followed by antiepileptics (37.5%). Rash and transaminitis resolved by 3 weeks, and 20% of patients, all female, developed autoimmune sequelae including Hashimoto's thyroiditis and an undifferentiated connective tissue disorder and occurred at an average of 14.5 weeks after diagnosis. LIMITATIONS This was a small retrospective study of an uncommon clinical diagnosis at a single institution. CONCLUSIONS Pediatric DRESS was most commonly caused by antibiotics which are being increasingly recognized in the literature as the predominant culprit medications. The development of autoimmune sequelae is a notable consequence that can present weeks after illness and may preferentially affect female patients.
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Affiliation(s)
- Kate E Oberlin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Ahmed K Alomari
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Anita N Haggstrom
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
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Mori F, Caffarelli C, Caimmi S, Bottau P, Liotti L, Franceschini F, Cardinale F, Bernardini R, Crisafulli G, Saretta F, Novembre E. Drug reaction with eosinophilia and systemic symptoms (DRESS) in children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:66-79. [PMID: 30830064 PMCID: PMC6502175 DOI: 10.23750/abm.v90i3-s.8167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Indexed: 02/07/2023]
Abstract
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe reaction to drugs. Incidence of DRESS in children is not well known and the mortality rate seems to be lower than 10%. Anticonvulsants are the main drugs involved both in adults and in children. The treatment of choice is intravenous immunoglobulins and corticosteroids used in synergy. Today there are not controlled clinical trials regarding DRESS treatment in children. Anyway, the prompt withdrawn of the offending drug is of paramount importance for a better prognosis. DRESS sequels may occur, consequently, follow-up visits are required at least until the first year after the reaction. (www.actabiomedica.it)
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy.
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Charfi O, Aouinti I, Zaiem A, Lakhoua G, El Aidli S, Kastalli S. Diclofenac induced drug rash with eosinophilia and systemic symptoms. Therapie 2018; 73:551-553. [DOI: 10.1016/j.therap.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/10/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
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Castellazzi ML, Esposito S, Claut LE, Daccò V, Colombo C. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in two young children: the importance of an early diagnosis. Ital J Pediatr 2018; 44:93. [PMID: 30111350 PMCID: PMC6094901 DOI: 10.1186/s13052-018-0535-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a serious life-treating condition characterized by skin eruption, fever, haematologic abnormalities, and multi-organ involvement that can be fatal if unrecognized, especially in patients with liver failure. Diagnosis may be difficult because it is rarely described in children and can mimic many different conditions. CASE PRESENTATION We report two cases of DRESS syndrome due to prolonged antibiotic treatment in young children in whom recovery occurred following different therapeutic approaches. A previously healthy 5-year-old boy had been receiving intravenous vancomycin for right wrist and left elbow osteomyelitis and developed DRESS syndrome on day 30. The patient achieved a complete resolution of all symptoms with pulse methylprednisolone followed by oral prednisone. A 4-year-old girl with cystic fibrosis, pancreatic insufficiency, chronic pulmonary colonization by Gram-positive bacteria admitted for pulmonary exacerbation was treated with intravenous piperacillin-tazobactam and tobramycin. After 14 days of treatment, she developed DRESS syndrome: antibiotic treatment was therefore stopped, and without any further therapy, a progressive resolution of the patient's clinical features was observed within 7 days, while the normalization of laboratory abnormalities was achieved at 14 days. CONCLUSIONS Our cases highlight that paediatricians should be aware of the clinical presentations of and therapeutic approaches for DRESS syndrome, especially in children receiving long-term antibiotic treatment. The removal of the offending drug is crucial and may be the only life-saving measure. In more aggressive cases, corticosteroid or other immunosuppressive drugs should be considered to achieve the best outcome.
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Affiliation(s)
- Massimo Luca Castellazzi
- Cystic Fibrosis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06132 Perugia, Italy
| | - Laura Elisabetta Claut
- Cystic Fibrosis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy
| | - Valeria Daccò
- Cystic Fibrosis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy
| | - Carla Colombo
- Cystic Fibrosis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy
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Saglietti C, Sciarra A, Abdelrahman K, Schneider V, Karpate A, Nydegger A, Sempoux C. Autoimmune Gastritis in the Pediatric Age: An Underestimated Condition Report of Two Cases and Review. Front Pediatr 2018; 6:123. [PMID: 29765934 PMCID: PMC5939145 DOI: 10.3389/fped.2018.00123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Diagnosis of pediatric autoimmune gastritis (AIG) in children is important due to poor outcome and risk of malignancy. This condition is often underestimated in the clinico-pathologic diagnostic work-up, leading to delayed time-to-diagnosis. To increase the awareness of this condition in the pediatric population, we present two cases encountered at our institution, discuss their clinical, biological, and histological presentations in relation with evidence from the literature, and propose an algorithm for diagnosis and follow-up of AIG in children. Case presentation: Two patients (12 and 17 years old) presented with iron deficiency anemia and negative family history for autoimmune disorders. In both cases, the final diagnosis of autoimmune gastritis was delayed until pathological examination of endoscopic gastric biopsies showed atrophy of oxyntic glands. Helicobacter pylori search was negative. Follow up biopsies revealed persistent disease. Literature review on this condition shows unclear etiology and poor long term outcome in some patients because of increased risk of malignancy. Conclusions: AIG should be considered in the differential diagnosis of iron deficiency anemia in the pediatric population.Standardized clinico-pathologic work-up is mandatory. Endoscopic follow-up should be performed due to the risk of malignancy.
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Affiliation(s)
- Chiara Saglietti
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Amedeo Sciarra
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Karim Abdelrahman
- Gastroenterology and Hepatology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Vanessa Schneider
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Arti Karpate
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas Nydegger
- Pediatric Gastroenterology Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
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