, 8 tweets, 4 min read
1/8 #FOAMPed #PEM #FOAMed

Another chat in CED last night about using Ibuprofen in chickenpox, and thought it would make a nice tweetorial! (for more detail check out end of thread for link to blog and podcast!)

Ever heard you shouldn't given ibuprofen to kids with chickenpox?
The concern is about increased risk of severe skin infections, in particular the dreaded necrotising fasciitis (nec fasc) with group A Strep (GAS).

This first popped up in the 60's with case reports of a GAS outbreak associated with ibuprofen.

A few case control studies have been done since, with small sample sizes (Nec fasc is rare!) which seemed to confirm an association.

But, as you all know, correlation does not equal causation!

The problem is "confounding by indication" - we don't know if these children got more sick because they had ibuprofen, OR if they were given ibuprofen because they were more sick in the first place!
Because a suitable alternative exists (paracetamol) the advise has been to avoid ibuprofen - just in case.

Seems fair! But what about in CED when the kids had paracetamol and it's not cut the mustard? How high a risk do you run by giving ibuprofen, IF the risk really exists?
Some rough maths:

-Pop incidence of chicken pox (<5yrs) 13,000/100,000/yr
-Pop Incidence of nec fasc in chicken pox 0.05/100,000/yr
-Risk of nec fasc in chicken pox therefore 0.04/10,000/yr
-Ibuprofen OR=5 (=0.2/10,000/yr)

=Absolute risk increase 0.0016%
What does that number mean? It's just a very small number!

It makes sense for parents to not routinely use ibuprofen, but as a HCP if paracetamol just isn't doing the job, you can discuss with parents whether benefits may outweigh the small, theoretical increased risk.
Thanks for reading it all!

For more detail check out the blog on @DFTBubbles


And/or podcast with the lovely @ianlewins on @2_paeds

Soundcloud: bit.ly/2kMm8Tb

iTunes: apple.co/2kyrh0W

Spotify: spoti.fi/2mphx9G
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