Intoxicación no intencionada por anticatarrales: medicamentos poco útiles y potencialmente tóxicos / Unintentional poisoning by cough and cold medications: Drugs with little usefulness and potential toxicity

Introducción: El uso de medicamentos para aliviar los síntomas del «resfriado común» en los niños es muy frecuente. A la falta de evidencia científica que avale su utilidad se suma la potencial toxicidad, habiéndose descrito intoxicaciones graves e incluso letales. El objetivo de este estudio es describir las características clínico-epidemiológicas de los pacientes atendidos en un servicio de urgencias pediátricas por sospecha de intoxicación no intencionada por anticatarrales. Material y métodos: Estudio analítico-observacional de los pacientes con edad inferior a 18 años atendidos en un servicio de urgencias pediátricas por sospecha de intoxicación no intencionada por un medicamento anticatarral, entre julio-2012 y junio-2020. Se clasificó la gravedad según el Poisoning Severity Score (PSS): PSS-0=sin toxicidad; PSS-1=toxicidad leve; PSS-2=moderada; PSS-3=grave; PSS-4=letal. Si la intoxicación se produjo en el transcurso de un tratamiento con el medicamento, se determinó si la edad del paciente estaba incluida en las indicaciones terapéuticas según ficha técnica. Resultados: Se recogieron 63 casos. Los medicamentos implicados fueron: anticongestivos y mucolíticos (31; 49,2%), antitusígenos (26; 41,2%), broncodilatadores orales (6; 9,5%). Se clasificaron según gravedad en: PSS-0=40 (63,5%), PSS-1=21 (33,3%), PSS-2=1 (1,6%) y PSS-3=1 (1,6%). En 29 pacientes (46%) existía antecedente de uso terapéutico; de estos, en 15 casos (51,7%) la edad del paciente era inferior a la recomendada en ficha técnica. En 14 pacientes (22,2%) la intoxicación se produjo por error en la dosis administrada por los cuidadores. Conclusión: Aunque la evidencia científica no recomienda medicamentos anticatarrales en niños, se siguen produciendo intoxicaciones no intencionadas por estos fármacos, en ocasiones moderadas o graves. (AU)

Introduction: The use of medications to relieve the symptoms of the “common cold” in children is very frequent. In addition to the lack of scientific evidence supporting its usefulness, there is evidence of potential toxicity, and serious and even fatal cases of intoxication have been described. The objective was to describe the clinical and epidemiological characteristics of the patients treated in a paediatric emergency department for suspected unintentional intoxication by a cold medicine. Material and methods: Observational and analytical study of patients aged less than 18 years managed in a paediatric emergency department for suspected unintentional poisoning by a cold medicine between July 2012 and June 2020. We classified severity according to the Poisoning Severity Score (PSS): PSS-0=no toxicity; PSS-1=mild toxicity; PSS-2=moderate; PSS-3=severe; PSS-4=lethal. If the intoxication occurred while the patient was in active treatment with the drug, we determined whether the patient's age was in the applicable range established in the therapeutic indications provided in the summary of product characteristics. Results: The study included data for 63 cases. The drugs involved were decongestants and mucolytics (31; 49.2%), antitussives (26; 41.2%) and oral bronchodilators (6; 9.5%). The distribution by severity was 40 cases with PSS-0 (63.5%), 21 with PSS-1 (33.3%), 1 with PSS-2 (1.6%) and 1 with PSS-3 (1.6%). In 29 patients (46.0%) there was a history of therapeutic use; in 15 of these cases (51.7%) the age was lower than recommended in the summary of product characteristics. In 14 patients (22.2%) the intoxication was due to administration of the wrong dose by caregivers. Conclusion: Although scientific evidence does not support the use of cold medicines in children, unintentional intoxications by these drugs keep happening, in some cases causing moderate or severe symptoms. (AU)

Over-the-Counter Medicines and Diabetes Care.

OBJECTIVES: People with diabetes turn to over-the-counter (OTC) medicines for many ailments. The focus of this brief review is the impact common OTC medicines might have on this group of patients. METHODS: Three types of OTC medicines were selected as most deserving of attention: 3 herbal agents, nonsteroidal anti-inflammatory drugs (NSAIDs) and cough/cold products. Existing literature was used to determine precautions that might be in order. RESULTS: Herbal/natural agents with the potential to impact blood sugar have been identified in various reports. In discussing 3, glucosamine and cinnamon (at doses recommended on commercial products) should have minimal impact on diabetic management, whereas St. John's wort is a concern involving potential drug interactions. For colds, of about 11 active ingredients, only decongestants (primarily oral) need be considered for their possible effects on blood sugar. Finally, NSAIDs (even at OTC doses) must be used with caution, given their cardiovascular, renal and gastrointestinal risks. Care guidelines do encourage patients to take ownership of their condition. Yet the ability to self-medicate safely is not a certainty. In spite of easy access and a reasonable level of safety, OTC medicines still can negatively impact a user. NSAIDs available without prescription continue to cause concern. CONCLUSIONS: Before the use of any medicine, a person must ensure it will be safe. A health-care provider can be asked for assistance, but that option may not always be employed. Package information is there to provide critical information in lieu of that, something the self-medicating patient will, it is hoped, embrace.

Comparison of the Benefit Feeling Rate Based on the Sho of OTC Kakkonto, Cold Remedy and Cold Remedy with Kakkonto Combination Product.

Kakkonto (KK), a traditional Japanese Kampo formulation for cold and flu, is generally sold as an OTC pharmaceuticals used for self-medication. Kampo formulations should be used according to the Sho-symptoms of Kampo medicine. These symptoms refer to the subjective symptoms themselves. Although with OTC pharmaceuticals, this is often not the case. We surveyed the relationship of agreement of Sho with the benefit feeling rate (BFR) of patients who took KK (n=555), cold remedies with KK (CK, n=315), and general cold remedies (GC, n=539) using internet research. BFR of a faster recovery was greater in participants who took the medication early and who had confidence in their physical strength in all treatment groups. BFR was significantly higher in the GC group than in the KK group for patients with headache, runny nose, blocked nose, sneezing, and cough. BFR was also significantly higher in the GC group than in the CK group for headache (males) and cough (females). BFR was the highest in the KK group for stiff shoulders. All cold remedies were more effective when taken early, and the larger the number of Sho that a patient had, the greater the BFR increased. Therefore, a cold remedy is expected to be most effective when there are many cold symptoms and when it is taken at an early stage of the common cold.

Tratamiento antigripal: fármacos actualmente utilizados y nuevos agentes en desarrollo / Anti-influenza treatment: drugs currently used and under development

La gripe es una enfermedad contagiosa altamente prevalente y con significativa morbimortalidad. El tratamiento disponible con fármacos antivirales, de ser administrado de forma precoz, puede reducir el riesgo de complicaciones severas; sin embargo, muchos tipos de virus desarrollan resistencia a estos fármacos, reduciendo notablemente su efectividad. Ha habido un gran interés en el desarrollo de nuevas opciones terapéuticas para combatir la enfermedad. Una gran variedad de fármacos han demostrado tener actividad antiinfluenza, pero aún no están disponibles para su uso en la clínica. Muchos de ellos tienen como objetivo componentes del virus, mientras que otros son dirigidos a elementos de la célula huésped que participan en el ciclo viral. Modular los componentes del huésped es una estrategia que minimiza el desarrollo de cepas resistentes, dado que estos no están sujetos a la variabilidad genética que tiene el virus. Por otro lado, la principal desventaja es que existe un mayor riesgo de efectos secundarios asociados al tratamiento. El objetivo de la presente revisión es describir los principales agentes farmacológicos disponibles en la actualidad, así como los nuevos fármacos en estudio con potencial beneficio en el tratamiento de la gripe

Influenza is a very common contagious disease that carries significant morbidity and mortality. Treatment with antiviral drugs is available, which if administered early, can reduce the risk of severe complications. However, many virus types develop resistance to those drugs, leading to a notable loss of efficacy. There has been great interest in the development of new drugs to combat this disease. A wide range of drugs has shown anti-influenza activity, but they are not yet available for use in the clinic. Many of these target viral components, which others are aimed at elements in the host cell which participate in the viral cycle. Modulating host components is a strategy which minimizes the development of resistance, since host components are not subject to the genetic variability of the virus. The main disadvantage is the risk of treatment-related side effects. The aim of this review is to describe the main pharmacological agents currently available and new drugs in the pipeline with potential benefit in the treatment of influenza

Uso de anticatarrales en menores de 14 años en consultas de Atención Primaria / Use of cold and cough medications prescribed in Primary Care clinics for children less than 14 years

OBJETIVO: Conocer el perfil de prescripción de anticatarrales en las consultas de Pediatría de Atención Primaria en el Área V del Servicio de Salud del Principado de Asturias y valorar su idoneidad. Material y métodos; Estudio transversal, descriptivo y retrospectivo. Se analizaron las prescripciones para el tratamiento de los procesos respiratorios en 6 consultas de Pediatría de Atención Primaria en el Área Sanitaria V del Servicio de Salud del Principado de Asturias en el año 2011. Se valoraron la idoneidad de los tratamientos prescritos mediante las fichas técnicas de los fármacos y las indicaciones clínicas según el diagnóstico, siguiendo las recomendaciones de guías clínicas, protocolos o en su defecto la bibliografía disponible más actual. RESULTADOS: Se analizaron 424 anticatarrales: 249 antitusígenos, 155 mucolíticos y 20 clasificados en otros. La media de edad de los pacientes es de 5 años. Un 85,1% de las prescripciones se consideran inadecuadas. El 11,6% de ellos fueron prescritos fuera de ficha técnica. Se consideraron inadecuados el 82,8% de los asociados al diagnóstico R74 y el 73% al R05. Todos los fármacos de los menores de 6 años se consideraron inadecuados. El 99,4% de los mucolíticos/otros y el 75,1% de los antitusígenos se consideraron inadecuados. CONCLUSIONES: Se observa un alto porcentaje de prescripción de fármacos anticatarrales en menores de 14 años en nuestro medio, encontrándose un 85% de las prescripciones inadecuadas. Los niños deberían recibir solo medicamentos con una relación beneficio-riesgo favorable; para ello es necesario mejorar la información sobre el uso pediátrico y promover acciones formativas dirigidas a los padres y a los profesionales sanitarios

OBJECTIVE:To evaluate cold and cough medications and their suitability in children in Primary Health Care in Area V of the Asturian Health Service. MATERIAL AND METHODS: A cross-sectional, descriptive and retrospective study was conducted in which an analysis was performed of the respiratory diseases and the prescriptions of 6 Primary Health Care paediatricians who worked in Area V of the Asturian Health Service in 2011. An evaluation was made on the suitability of these medications. An analysis was also made of the drug datasheet and clinical recommendations (clinical guidelines, protocols or reports). RESULTS: A total of 424 cold and cough drugs: 249 antitussives, 155 mucolytics, and 20 'others' were analyzed. The mean age was 5 years old. There was a total of 85.1% unsuitable prescriptions. Off-label drugs were used in 11.6%. The prescribing was considered unsuitable in 82.8% of prescriptions associated with R74, and 73% of R05. All of the prescription drugs in children under 6 years old were unsuitable. Mucolytics/'others' were not suitable in 99.4%, nor antitussives in 75.1%. CONCLUSIONS: There is a high level of cold and cough drugs being prescribed in children, with 85% of these being unsuitable. Children should only receive drugs with a good risk and benefit ratio. Pediatricians should try to improve the information about pediatric drug use and spread this information to parents, doctors and nurses

Efecto sobre la salud de un grupo de pacientes crónicos polimedicados en una farmacia comunitaria / Effects of the pharmacotherapeutical follow-up in a community pharmacy on aged patients with multiple medications

Introducción: El seguimiento farmacoterapéutico (SFT) puede suponer importantes beneficios para la salud de los pacientes mayores polimedicados. Objetivos: Valorar la influencia de la implantación del SFT en la salud de nuestros pacientes. Evaluar la efectividad de las intervenciones farmacéuticas (IF). Analizar los resultados negativos asociados a la medicación (RNM) en función del principio activo y problema de salud. Método: Estudio longitudinal, descriptivo y no aleatorizado en mayores de 65 años polimedicados, siguiendo la metodología delprograma ConSIGUE. Los datos, correspondientes a diez pacientes, se recopilaron de estados de situación (ES), cuestionarios de utilización de recursos sanitarios, encuestas de calidad de vida y registros de RNM e IF. Resultados: Hubo reducción apreciable en número de principios activos, problemas de salud (PS), RNM y visitas a urgencias. Se registró un incremento de la percepción subjetiva de la calidad de vida. En la revisión, se retiró algún medicamento al 80% de los pacientes. Registramos 69 IF, siendo aceptadas 61 (~90%). Detectamos 28 RNM: 20 fueron resueltos (70%) y 2 son todavía objeto de seguimiento. Omeprazol, ácido acetilsalicílico y acenocumarol, estuvieron implicados en el 30% de los RNM. La prevención de gastrolesión, junto con patologías como diabetes y anticoagulación, se asociaron con el 60% de los RNM. Conclusiones: La inclusión en el SFT ha supuesto importantes beneficios en salud para nuestros pacientes. El uso extensivo de fármacos considerados seguros puede contribuir a la aparición de RNM en pacientes crónicos y polimedicados

Introduction: The implementation of a pharmacotherapeutical follow-up program can suppose many health benefits for aged patients with multiple medications. Objectives: The main objectives are to evaluate the impact of this program on patients’ health and the effectiveness of the pharmaceutical interventions. On the other hand, to analyze the negative results associated with the medication according to the active ingredient or the health problem involved. Methods: It was carried out a longitudinal, descriptive and non randomized study in aged patients with multiple medications, following ConSIGUE methodology. Data, concerning ten patients, were collected from assessment forms, use questionnaires of healthcare resources, quality of life surveys and negative results associated with medication and pharmaceutical interventions records. Results: There was a reduction in the number of active ingredients, health problems and hospitalization and emergency room visits. In contrast, an increase in the patients’ quality of life was found. At least, one medicine (outdated medicines or non active prescriptions) was withdrawn in 80% of the patients during the medication review. We recorded 69 pharmaceutical interventions from which 61 were accepted. 20 out of 28 negative results associated with medication were solved while 2 are still under study. Omeprazole, acetylsalicylic acid and acenocumarol were found to be responsible for 30% of negative results associated with medication. 60% of the negative outcomes recorded were associated to the prevention of ulcers and pathologies such as diabetes and anticoagulation. Conclusions: The inclusion in a pharmacotherapeutical follow-up program resulted in improved health outcomes of our patients. The extensive use of safe drugs may contribute to negative phamacotherapeutical results in aged patients with multiple medications

A retrospective study on the usage of cough and cold medications in viral respiratory tract infections in Taiwanese children.

OBJECTIVE: We sought to describe the epidemiology of viral respiratory-tract infections and patterns in prescriptions of cough and cold medications among young children who were suffering from viral respiratory tract infections (vRTIs). METHODS: We conducted a cross-sectional study to examine vRTI-episode occurrence and cold-medication utilization in outpatients in 2007 using the National Health Insurance Research Database (NHIRD) in Taiwan. One-third of the children under 12 years of age who had at least one outpatient visit for a vRTI as randomly selected from NHIRD were included in the analysis. RESULTS: A total of 895,942 children had a diagnosis of vRTI (6,144,336 visits) during 2007, 58% of whom were aged 6 to 12 years, and 52% of whom were male. The mean cumulative incidence of vRTIs by ages were 5.6 in infancy, 7.1 in preschool, and 4.0 in school children. The average number of cough and cold medications without other drugs prescribed per visit was two to three. Among cough and cold medications, antihistamines for systemic use were prescribed most frequently (20%), followed by mucolytics (12%), selective beta-2 agonists (11%), decongestants for systemic use (10%), and analgesic-antipyretics including acetaminophen (7%) or non-steroid anti-inflammatory drugs (6%). There was considerable variation of prescriptions, which increased with increasing age, where the top 20 prescription accounted for only 36%, 30%, and 25% of all prescriptions in infants, preschool, and school age children, respectively. CONCLUSIONS: A more rational use of medicines for treatment of vRTIs in children in Taiwan needs to be developed.

Use of active ingredient information for low socioeconomic status parents' decision-making regarding cough and cold medications: role of health literacy.

OBJECTIVE: Parent administration of multiple medications with overlapping active ingredients places children at risk for overdose. We sought to examine how parents use active ingredient information as part of the process of selecting a cough/cold medication for their child and how health literacy plays a role. METHODS: Experimental study of parents of children presenting for care in an urban public hospital pediatric clinic. Parents were asked to determine which of 3 cough/cold medications could be given to relieve a child's cold symptoms, as part of a scenario in which they had already given a dose of acetaminophen; only 1 did not contain acetaminophen. Primary dependent variable: correct selection of cough/cold medication by using active ingredient as the rationale for choice. Primary independent variable: parent health literacy (Newest Vital Sign test). RESULTS: Of 297 parents, 79.2% had low health literacy (Newest Vital Sign score 0-3); 35.4% correctly chose the cough/cold medication that did not contain acetaminophen. The proportion of those who made the correct choice was no different than expected from chance alone (Goodness of fit test; χ(2) = 2.1, P = .3). Only 7.7% chose the correct medication and used active ingredient as the rationale. Those with adequate literacy skills were more likely to have selected the correct medication and rationale (25.8% vs 3.0% (P = .001); adjusted odds ratio 11.1 (95% confidence interval 3.6-33.7), after we adjusted for sociodemographics, including English proficiency and education. CONCLUSIONS: Many parents, especially those with low health literacy, do not use active ingredient information as part of decision-making related to administering multiple medications.

Prescripción de fármacos anticatarrales de uso sistémico a niños de 0-13 años. Un problema no resuelto / Prescription of systemic cold and cough drugs to children 0-13 years old. An unresolved problem

Introducción y objetivos: La infección de las vías respiratorias superiores es el motivo de consulta pediátrica más frecuente, generando un elevado volumen de prescripción de fármacos con desfavorable relación riesgo-beneficio. El objetivo del estudio es describir la prescripción de anticatarrales por vía sistémica a menores de 14 años en Castilla y León y analizar su variabilidad. Población y métodos: Se contabilizaron las prescripciones de los subgrupos R05 (antitusivos y mucolíticos) y R01B (simpaticomiméticos) realizadas a menores de 14 años en el sistema público de salud entre 2005-2010. Se analizaron las prescripciones como tasas crudas y ajustadas por edad, y se realizó un análisis multivariante (regresión de Poisson) de la variabilidad relacionada con el área sanitaria, el ámbito urbano/rural, la edad y el año de prescripción. Resultados: Hubo 806.785 prescripciones de anticatarrales sistémicos realizadas a una población expuesta de 1.580.229 personas-año. Las tasas de prescripción (por 100 personas-año) fueron de 20,7 (antitusivos), 7,0 (simpaticomiméticos) y 23,4 (mucolíticos). Las tasas eran mayores en los niños menores de 4 años. La prescripción máxima de mucolíticos y simpaticomiméticos ocurrió a la edad de 1 año (tasas de 41,9 y 18,7) y la de antitusivos a los 3 años (35,7). El análisis multivariante demostró una mayor prescripción en el medio rural y diferencias notables entre áreas. El número de prescripciones disminuyó entre 2005 y 2010, pero no hubo una tendencia estable en esa reducción. Conclusiones: Entre 2005 y 2010 la prescripción de anticatarrales sistémicos fue alta, alejada de las recomendaciones internacionales de tratamiento y con una marcada variabilidad geográfica(AU)

Introduction and objectives: Upper respiratory tract infections are the most common cause of paediatric consultation, generating a high volume of prescriptions of drugs with unfavourable risk-benefit ratio. The aim of this study is to describe the prescription of systemic cough and cold medicines to children under 14 years of age in Castilla y León and analyse its variability. Population and methods: A count was made of the prescriptions for the R05 therapeutic subgroup (antitussives and mucolytics) and the R01B pharmacological therapeutic subgroup (nasal decongestants for systemic use), prescribed for children under the age of 14 in the Public Health System between 2005-2010. The number of prescriptions was analysed as crude and age-adjusted rates, as well as a a multivariate analysis (Poisson regression) of the variability associated with health area, the urban/rural environment, age, and year of prescription. Results: There were 806,785 prescriptions for systemic cough and cold drugs given to an exposed population of 1,580,229 person-years. Prescription rates (per 100 person-years) were 20.7 (antitussives), 7.0 (sympathomimetic) and 23.4 (mucolytics). These drugs were employed more often in children <4 years. The prescription of mucolytics and sympathomimetics was highest at age of 1 year (rates=41.9 and 18.7, respectively) and of antitussives at 3 years (35.7). Multivariate analysis showed that in rural areas the prescription was higher than in urban areas, and that there were also significant differences between health areas. Conclusions: Between 2005 and 2010 there was a high prescription of systemic cough and cold medicines, especially in children under 2 years old, and often outside the recommended conditions of use, and there was a high geographic variabilty(AU)

Reduction of common cold symptoms by encapsulated juice powder concentrate of fruits and vegetables: a randomised, double-blind, placebo-controlled trial.

Dietary supplements have been suggested in the prevention of the common cold, but previous investigations have been inconsistent. The present study was designed to determine the preventive effect of a dietary supplement from fruits and vegetables on common cold symptoms. In a randomised, double-blind, placebo-controlled trial, healthcare professionals (mainly nursing staff aged 18-65 years) from a university hospital in Berlin, Germany, were randomised to four capsules of dietary supplement (Juice Plus+®) or matching placebo daily for 8 months, including a 2-month run-in period. The number of days with moderate or severe common cold symptoms within 6 months (primary outcome) was assessed by diary self-reports. We determined means and 95 % CI, and differences between the two groups were analysed by ANOVA. A total of 529 subjects were included into the primary analysis (Juice Plus+®: 263, placebo: 266). The mean age of the participants was 39·9 (sd 10·3) years, and 80 % of the participants were female. The mean number of days with moderate or severe common cold symptoms was 7·6 (95 % CI 6·5, 8·8) in the Juice Plus+® group and 9·5 (8·4, 10·6) in the placebo group (P = 0·023). The mean number of total days with any common cold symptoms was similar in the Juice Plus+® and in the placebo groups (29·4 (25·8, 33·0) v. 30·7 (27·1, 34·3), P = 0·616). Intake of a dietary supplement from fruits and vegetables was associated with a 20 % reduction of moderate or severe common cold symptom days in healthcare professionals particularly exposed to patient contact.

Medidas generales de prevención de accidentes hipobáricos-hiperbáricos en la esfera otorrinolaringológica / General measures for preventing hypo-hyperbaric accidents in otorhinolaryngology

Los accidentes barotraumáticos en la esfera otorrinolaringológica son muy frecuentes, especialmente el de oído medio. Prevenirlos es una de las tareas en las que más hincapié debemos hacer. Para ello, debemos realizar un estudio anatómico de vías altas en el que analicemos las fosas nasales y el cavum, así como estudios de función tubárica y estudios radiológicos para cuantificar la neumatización mastoidea. Es importante conocer las maniobras de compensación tubárica más comunes, así como la fisiopatología del propio barotrauma. En las personas con el diagnóstico de enfermedades que comprometen la función tubárica o el normal drenaje de los ostia sinusales, podemos aplicar medidas y tratamientos específicos que solucionan los problemas de compensación de presiones. En el medio aéreo se dispone de unas medidas muy sencillas encaminadas a la prevención de los barotraumas de oído (AU)

Barotrauma accidents are highly frequent in otorhinolaryngology, especially those involving the middle ear. Emphasis should be placed on preventing these lesions. To do this, anatomical study of the upper airways should be performed with analysis of the nasal fossae and cavum, as well as evaluation of Eustachian tube function and radiological tests to quantify mastoid pneumatization. Otorhinolaryngologists should be familiar with the most common maneuvers of tubal compensation, as well as the physiopathology of barotrauma. In patients diagnosed with disorders that can compromise Eustachian tube function or normal drainage of the sinus ostium, specific measures and treatments can be applied that solve the problems of pressure compensation. In flying, several simple measures are available to prevent barotrauma to the ear (AU)