ABSTRACT
OBJECTIVE: To determine the impact of industry and Food and Drug Administration initiatives implemented to limit the use of over-the-counter (OTC) cough and cold medications in children younger than 6 years of age. STUDY DESIGN: This is a retrospective database study of OTC cough and cold medication ingestions reported to US poison centers between 2000 and 2010. Data analyzed from the National Poison Data System included the month and year of ingestion, reason for ingestion, health care utilization, and medical outcome. Ingestion frequencies were stratified by age and reason. Data were divided into pre- and postintervention periods for comparative analysis. RESULTS: Unintentional ingestions of OTC cough and cold medications decreased 33.4% and therapeutic errors by 46.0%. Health care facility referral declined for unintentional ingestions (28.9% <2 years of age, 19.9% 2-5 years of age, P < .0001) and therapeutic errors in children younger than 2 years of age (59.2%, P < .0001). Moderate and severe adverse outcomes decreased for unintentional ingestions in children younger than 2 years of age by 32.4% and by 21.3% in 2- to 5-year olds, P < .0001. CONCLUSIONS: The restriction of OTC cough and cold medications has led to a decline in unintentional ingestions, therapeutic errors, health care facility referral, and serious medical outcomes in children younger than 2 years of age. There has also been a decline in ingestions in 2- to 5-year-old children.
Subject(s)
Antitussive Agents/poisoning , Cough/drug therapy , Drug Labeling , Nonprescription Drugs/poisoning , Poison Control Centers , Poisoning/epidemiology , Child , Child, Preschool , Databases, Factual , Expectorants/poisoning , Histamine Antagonists/poisoning , Humans , Infant , Nasal Decongestants/poisoning , Patient Safety , Retrospective Studies , Treatment Outcome , United States , United States Food and Drug AdministrationSubject(s)
Antitussive Agents/poisoning , Atrioventricular Block/chemically induced , Codeine/poisoning , Muscle Weakness/chemically induced , Nonprescription Drugs/adverse effects , Atrioventricular Block/diagnosis , Atrioventricular Block/drug therapy , Chronic Disease , Cough/diagnosis , Cough/drug therapy , Dose-Response Relationship, Drug , Drug Combinations , Drug Overdose , Electrocardiography , Electromyography , Expectorants/poisoning , Female , Follow-Up Studies , Humans , Infusions, Intravenous , Methylprednisolone/therapeutic use , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/drug therapy , New Zealand , Poisoning/drug therapy , Risk Assessment , Severity of Illness Index , Treatment Outcome , Upper ExtremitySubject(s)
Acidosis/chemically induced , Ammonium Chloride/poisoning , Expectorants/poisoning , Kidney Failure, Chronic/therapy , Renal Dialysis , Ammonium Chloride/therapeutic use , Cough/drug therapy , Expectorants/therapeutic use , Female , Follow-Up Studies , Humans , Middle Aged , Nonprescription Drugs/poisoning , RecurrenceABSTRACT
OBJECTIVE: To discover the cause of acute renal failure in 36 children aged 2 months to 6 years who were admitted to two hospitals in Delhi between 1 April and 9 June 1998. METHODS: Data were collected from hospital records, parents and doctors of the patients, and district health officials. Further information was obtained from house visits and community surveys; blood and stool samples were collected from other ill children, healthy family members and community contacts. Samples of drinking-water and water from a tube-well were tested for coliform organisms. FINDINGS: Most of the children (26/36) were from the Gurgaon district in Haryana or had visited Gurgaon town for treatment of a minor illness. Acute renal failure developed after an episode of acute febrile illness with or without watery diarrhoea or mild respiratory symptoms for which the children had been treated with unknown medicines by private medical practitioners. On admission to hospital the children were not dehydrated. Median blood urea concentration was 150 mg/dl (range 79-311 mg/dl) and median serum creatinine concentration was 5.6 mg/dl (range 2.6-10.8 mg/dl). Kidney biopsy showed acute tubular necrosis. Thirty-three children were known to have died despite being treated with peritoneal dialysis and supportive therapy. CONCLUSION: Cough expectorant manufactured by a company in Gurgaon was found to be contaminated with diethylene glycol (17.5% v/v), but a sample of acetaminophen manufactured by the same company tested negative for contamination when gas-liquid chromatography was used. Thus, poisoning with diethylene glycol seems to be the cause of acute renal failure in these children.
