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Thu Sep 7 21:52:09 BST 2006

 Tim, while I've got to agree that Paracetamol/Acetaminophen is one of the safer over the counter drugs on the market, I don't believe that Reye's syndrome has been associated with the non salicylate NSAIDS anywhere along the line. I know that in the almost 20 years since I graduated from Medical school (which coincided with the rise of the use of Ibuprofen instead of salicylates as the alternative pediatric antipyretic), I can remember seeing maybe one case of Reye's syndrome, and that was in my internship year. 2003 statistics from the US CDC showed a total of five (5) deaths in the US, all under the age of 9 years, for Reye's syndrome. I'm reasonably sure that I alone treated more cases of suspected Paracetamol/Acetaminophen toxicity in that year. The same report http://www.cdc.gov/nchs/data/statab/mortfinal2003_worktableorigi.pdf indicates that there were 210 deaths over all (5 under age 9 years) due to accidental ingestion of all non opiod pain relievers, without breaking it down as to type- another 242 deaths (none under age 10 years) were attributed to the deliberate ingestion of the same substances.

I have had several cases of Juvenile Rheumatoid arthritis and Juvenile Neurfibromatosis (patients age 5 to under age 15 years) that had to alternate between Ibuprofen and Naproxen to obtain satisfactory results since my graduation, and they tolerated the Naproxen quite well as long as it was given in weight appropriate doses and taken with food.

I don't generally use Diclofenac in kids under about age 15, due to the lack of available titrations for that drug.

 ck
Charles S. Krin, DO, FAAFP

-----Original Message-----
From: tch at sun.ac.za
To: trauma-list at trauma.org
Sent: Wed, 6 Sep 2006 11:48 PM
Subject: RE: Ibuprofen or Naproxyn is Head or muscular skeletal trauma

International pharmacology concensus:

Rather paracetamol than other NSAID's in children due to the incidence of Reye 
Syndrome which leads to fatal hepatic failure and encephalopathy.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
Program Manager: Emergency Medicine (SU)
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Department of Surgery Room 4064
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
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Ibuprofen or Naproxyn is Head or muscular skeletal trauma