Why medical professionals are sceptical about giving Tylenol to children - Research Paper Example

Introduction Tylenol is a very efficient and safe anti-pyretic (fever reducing) and analgesic (pain-killing) agent in children. The generic name for Tylenol (brand name) is Acetaminophen. Presently, in the US, Tylenol is the most widely used painkiller, with Americans taking more than 8 billion pills (capsules or tablets) of Tylenol every year. It is also available as an over-the-counter drug since the year 1960 and studies indicate that the drug has few severe adverse effects provided that one does not exceed the recommended dosage. In effect, the use of Tylenol in place of aspirin for fever treatment in infants has largely reduced the incidence of Reye's syndrome, a lethal kind of liver failure. Moreover, in a recent assessment of over 28,000 children under acetaminophen treatment, there was no greater risk of anaphylaxis, acute gastrointestinal bleeding or severe renal failure (Lee, 1 & Heubi, 2). Despite these desirable safety records, medical professionals remain skeptical about administering Tylenol to children. This is because when the drug is taken in supra-therapeutic doses, acetaminophen-induced hepatotoxicity can be fatal. These include accidental overdose when children receive the drug together with cough/cold preparations, an inadvertent overdose when a child receives multiple acetaminophen doses that go beyond the recommendations of the manufacturer, or a deliberate overdose with a single dose going beyond 140 mg/kg. In a period of ten years at five hospitals in California, 73 children (under 19 years) showed signs of acetaminophen hepatotoxicity, with 62 out of 63 suicidal patients (three of whom required orthotropic liver transplant) and 9 of 10 patients with inadvertent overdoses living on (Heubi, 2). Chronic acetaminophen (APAP) toxicity has been identified in pediatric patients. In most cases, young, febrile children with reduced oral intake who received treatment with repeated acetaminophen doses fall victim of this condition. Chronic acetaminophen toxicity’s risk factors include young age, continued dispensation of high doses, poor oral intake, and fever. The diagnosis of chronic acetaminophen toxicity is not easy, because the presentation of the patient may seem to be a sign of the initial sickness. It is therefore important to consult a medical toxicologist or a poison control center regarding management strategies (Defendi, 1-4) The most current American Association of Poison Control Centers’ figures indicate that in the year 1994, there were 71 serious incidents of acetaminophen poisoning among children, with severe life-threatening or long-term effects in 10 of the children. According to The Food and Drug Administration, between 1970 and 1991, 13 children under the age of 13 died because of acetaminophen poisoning (Hepatitis Foundation International, 2). Another acetaminophen hepatotoxicity study in inadvertent cases of overdose reported a wide array of implicated doses, with the most common causes (about half of the cases) involving the administration of adult preparations to young ones and subsequent erroneous replacement of a higher-concentration preparation for a lower-concentration preparation. 55% of the patients passed away, five patients went through liver transplants, with four living on (Heubi, 2). According to some early reports published in the 1970's, incidences of chronic liver disease were reported in patients who used Tylenol in recommended doses for a long time. Scientists agree that though rarely, taking Tylenol in usual doses brings about considerable liver damage (Lee, 1). Lee also notes that Tylenol can bring about liver enzymes’ elevations in the blood suggesting liver injury. In a two weeks survey of 145 healthy individuals randomized to receive four grams of Tylenol or placebo every day, while 33-44% of individuals in the Tylenol group had ALT (a liver enzyme) elevations over three times the normal limits, no ALT elevations were noted in the placebo group. In the Tylenol group, the highest ALT elevation was over five-hundred, which is about ten times the normal upper limit. Once the individuals stopped taking Tylenol, all enzyme elevations went back to normal. Consequently, administered to healthy individuals for two weeks, recommended Tylenol dosage can bring about mild to moderate ameliorable injury to the liver (1). Recent studies in the British Journal Lancet (2008) indicate that Tylenol (acetaminophen) exposure during intrauterine development of the fetus or during the first year of childhood increased the risk of the development of asthma symptoms. The risk was dose-dependent – there was greater risk of developing asthma in children who frequently used Tylenol and vice versa. Moreover, the use of Tylenol in children aged 6-7 years as well as in the first year of life is linked to an increase in the risk of eczema and rhino-conjunctivitis symptoms. Fever control makes the immune system s less functional and compromised (Gorter & Peper, 101). According to Eneli and his co-authors, in the US, asthma incidence in the last 3 decades has increased by 75 percent with a remarkable increase particularly in children below five years of age (160 percent). Although this rise surpasses age, gender, geographic location and ethnicity, it has a disproportionate effect on minority groups, inner-city populaces and the socioeconomically underprivileged. Since the reason behind the surge in prevalence is not clear, scientists have proposed a number of hypotheses. These include a rise in environmental exposures to indoor allergens and synthetic materials, shifting meteorological patterns, the increasing obesity prevalence, heightened exposure to cockroaches, diet and antioxidant intake changes, reduced exposure to bacteria as well as childhood illnesses, and decreased use of aspirin (2). Additionally, there is a hypothesis that dysregulation or cytokine imbalance that takes place following environmental exposures all through infancy as well as early childhood induces lifelong T-helper type 2 dominance over T-helper type 1 (allergic over nonallergic) responses. It is clear that T-helper type 2 dominance augments the risk for atopic diseases, which among others include asthma. The first incidence of suggesting a link between acetaminophen and bronchoconstriction was in the year 1967. This was by Chafee and Settipane in a case report of a patient that was aspirin-intolerant. Of late, there has been a rebirth of interest in the role that acetaminophen plays particularly in the prevailing rise in asthma incidences. In the United States for instance, acetaminophen is the most common form of analgesia that is used particularly in children. It is commonly found in combination with other drugs such as cough or cold formulations and opiates (Eneli, et al., 3). Correspondingly, McBride explains that the epidemiologic association between the use of acetaminophen and the prevalence and severity of asthma in children, and even in adults, is well established. A clear suggestion from a variety of observations is that the use of acetaminophen has contributed to the recent increment in the prevalence of asthma in children. These include the strength as well as the consistency of the association across age, culture and geography; the timing of asthma prevalence and increased use of acetaminophen;and the biological plausible glutathione depletion mechanism in airway mucosa. Others include the dose-response association; the outcomes of a double-blind trial of acetaminophen and ibuprofen for fever treatment in asthmatic children; and the association between asthma prevalence and acetaminophen’s per-capita sales across nations. A good example is the explanation that Kogan and co-authors (quoted by Eneli and his co-authors) give – they explain that an estimate of approximately two thirds of analgesia that preschool-aged children in the US used over a 30-day study period was acetaminophen. Concurrent with acetaminophen use in children, there has been reported a large increase in asthma, principally among the pediatric populace. There is therefore a strong belief among scholars that acetaminophen is a risk factor for asthma and that the recent increase in asthma prevalence is directly attributable to this drug. In an experts Debate on whether Tylenol is safe for asthmatic children, Doctor John McBride, vice chair of pediatrics department and director of the Robert T. Stone Respiratory Center at Akron Children's Hospital, explained that the fundamental issue is that there is an epidemiological problem related to acetaminophen and asthma. He went on to suggest that healthcare providers should make it clear to parents that there are chances that acetaminophen is not safe. He reviewed the existing evidence linking acetaminophen and asthma for an article published in the December issue of Pediatrics. Among the sources in this article was the International Study of Allergy and Asthma in Childhood, which comprised over half a million children at a hundred and twenty-two centers in fifty-four individual nations. Two-fifth of these children were between six and seven years while the rest were majorly between thirteen and fourteen years old (Gordon, 2-7). Approximately one third of the older children reported using acetaminophen at least one time in each month. The researcher found out that in children who took acetaminophen more than once a year but less than once a month, the risk of current asthma was sixty-one percent higher in the 6 to 7-year old. The risk of having asthma was three times more for these young children whose frequency of taking acetaminophen was more than once a month. For the older children between the age of thirteen and fourteen years, they fared to some extent better with a rise in risk of forty-three percent in those who were taking the drug more than one time per year, but less than one time each month. For these older children whose frequency of taking acetaminophen was more than once a month, the risk of becoming asthmatic rose by two and a half times. Following his evaluation, McBride asserted that elimination of acetaminophen exposure in that teen group would bring down the rate of severe asthma symptoms by forty-three percent. It is important to point out that although not everyone is persuaded that the link seen in the new study is attributable to cause and effect, in McBride’s view and advice, patients should avoid it until there is an establishment of a good evidence that acetaminophen is safe (Gordon, 8-13). Conclusion Apparently, being one of the most commonly used antipyretic and analgesic medications in children; Tylenol has its own undesirable effects. An increasing body of multifaceted proof supported by biochemical explanations hint that using Tylenol regularly may negatively affect the functioning of the lung. Actually, numerous studies have acknowledged such a strong connection between Tylenol exposure and asthma and the fact that it is likely that a great deal of the remarkable rise of asthma in children over the last three decades has been linked to its use. This likelihood has received wide recognition. Nonetheless, devoid of a randomized clinical trial, critics have been reluctant to conclude that Tylenol/acetaminophen causes asthma and have not suggested adjustments in practice. There is need for physicians to be aware of analgesia intolerance in different patients of asthma. Nevertheless, recommending any adjustment in present patterns of analgesic prescription for asthmatic patients will be premature. Tylenol/acetaminophen use can also cause liver damage and make it shut down, resulting in death or permanent disability and in patients suffering from liver diseases, it is advisable that physicians limit its use. Works Cited Defendi, Germaine L. Pediatric Acetaminophen Toxicity Workup. Medscape. 2011. Web. Eneli, Ihuoma, et al. “Acetaminophen and the Risk of Asthma”. Chest, 127.2 (2005): 604-612. web. Hepatitis Foundation International. Two Cautions. 2010. Web. Heubi, James E. Confusion with Acetaminophen. 2006. Web. Lee, Dennis . Tylenol (Acetaminophen) Liver Damage. 2007. Web. McBride, John T. The Association of Acetaminophen and Asthma Prevalence and Severity. 2011. Web. Peper, Erik, and Gorter, Robert. Fighting Cancer: A Nontoxic Approach to Treatment. Berkeley, CA: North Atlantic Books. 2011. Print. Read More