Excessive crying and irritability in infants due to drugs

This study was performed to see the extent and magnitude of drug induced excessive crying in infants and to know the causative drugs, from July 2005 to June 2006. It is a prospective and descriptive study. All children under 1 year of age, who presented with excessive crying of recent onset as the main complaint and were receiving some medicines were included in the study. After getting detailed history [particularly drug history], the problem was explained to the parents, the suspected drug was stopped and the patients were called back for follow up after 48-96 hours. If the crying had not stopped, the diagnosis was reconsidered and patient was excluded from study analysis. If the crying had stopped, it was assumed that the drug was the cause of excessive crying. All the included patients were studied for age, diagnosis, month of the year, geographical origin and the causative drugs. A total of 227 patients were included in the analysis; out of this, 44 [19.38%] were less than imonth of age while 183 patients [80.62%] were above 1 month, 143 patients were suffering from upper respiratory infection and 78 from wheezy chest. Majority of the patients presented during winter months. About 3/4th of the patients were from D. I. Khan district but the remaining 1/4th were from nearby and remote districts like Mianwali and Layyah. Most frequent causative drug was Rondec-D drops [Abbot] in 13o patients. Other drugs were various cough preparations, promethazine [Phenergan], brochodilators, anti-emetics, metronidazole, anti-histamines, various herbal preparations, phenolbarbitone and various anti-diarrhoeals in a decreasing order of frequency. This problem can be reduced by avoiding these medicines in below 1-2 years of age. It is therefore recommended that these above drugs should not be promoted for use in infants and Rondec-D drops and other similar preparations may be withdrawn from the market

Treatment of the common cold.

BACKGROUND: Common colds are usually treated by the patients themselves with over-the-counter (OTC) cold medications. Many cough and cold remedies are available and sold freely without prescription. The authors conducted a study to compare the efficacy, adverse effects, the quality of life (QOL) and the patient's opinion and appreciation on the drugs (POD) between Dayquil/Nyquil and Actifed DM plus paracetamol syrup. METHOD: In this prospective, investigator-blinded clinical trial, 120 patients, aged between 15 and 60 years old, with common colds within 72 hours, who accepted the trial and gave informed written consent, were randomized into two treatment groups. One patient was excluded due to evidence of bacterial infection. Fifty-nine patients were treated with Dayquil/Nyquil (D/N group), while the other 60 patients had Actifed DM plus paracetamol (ADM/P group) for three days. On day 1 the patient's demographic data (sex, age, body weight, blood pressure, co-existing diseases/conditions, drug use, and allergy to any drugs), the most prominent symptoms and its duration were recorded. All patients were screened for bacterial infection by physical examination, complete blood count and sinus radiographs. The symptoms (nasal obstruction, rhinorrhea, sneezing, cough, sore throat, fever and headache) and signs (injected nasal mucosa, nasal discharge and pharyngeal discharge) were scored, based on 4-point scale (0 to 3), on days 1 and 4. Changing of the symptoms and QOL were recorded on the diary card. The patient's opinion and appreciation on the drugs (POD) was assessed on day 4. The effectiveness (the ability to lessen the symptoms and signs), QOL and POD between two treatments were compared. RESULTS: The demographic data between the two groups were similar. The four most common prominent symptoms of common colds in our series were cough (47.9%), sore throat (26.17%), rhinorrhea (8.4%) and headache (8.4%). However, both treatments were equally effective in lessening the symptoms (P = 0.426) and signs (P = 0.716) of common cold from days 1 to 4. The adverse effects were significantly higher in ADM/P group than in D/N group (p = 0.006). In contrast, QOL in terms of alertness, freshness and sound sleep improved from day 1 to day 3 in both treatments, but the overall day-3 score was significantly higher in the D/N group than the ADM/P group (1.85 +/- 1.83; 1.25 +/- 1.94: p = 0.024). POD in terms of convenience, flavour of drug, effectiveness of the drug and a need to repeat the drug assessed on day 4, was also significantly higher in the D/N group than the ADM/P group (10.68 +/- 2.56; 8.92 +/- 2.27: p < 0.001). CONCLUSION: Dayquil/Nyquil are as effective as Actifed DM plus paracetamol in controlling the symptoms and signs of the common cold, but have fewer adverse effects. The quality of life assessed during the use of the drugs was significantly higher in the Dayquil/Nyquil group, and according to the patients, they prefered Dayquil/Nyquil more than Actifed DM plus paracetamol.