Do not treat a child's fever with aspirin, nimesulide, or metamizole, do not give a minor a cold medicine that contains metamizole, and measure liquid fever medicine with the dosing device in the box

Aspirin is linked to Reye's syndrome, an illness that harms the brain and the liver, and about 3 in 10 of the sick children die. Nimesulide is forbidden under 12. Metamizole is forbidden under 18. Measure liquid fever medicine with the dosing device that comes in the box. Spoons at home differ a lot in size. Drops and the drinkable liquid may not be the same strength. The US example differs by 3 times. If you switch the form, do not feed the old number of milliliters.

Cost

No money. When you buy a fever medicine, glance at the generic name and the ingredient list.

Benefit

Reye's syndrome causes brain disease and fatty change in the liver, and it usually appears after influenza or chickenpox. In US national surveillance from 1981 to 1997, 1207 cases were reported in people under 18. Salicylate, the ingredient in aspirin-type drugs, could be measured in the blood of 82% of the sick children. The overall share who died was 31%. Warnings about salicylate drugs began in 1980. That year 555 cases were reported, the peak. From 1987 on, each year has stayed at no more than 36 cases. In 2011 the national drug regulator banned oral nimesulide for children under 12. In 2020 it banned metamizole tablets for children and adolescents under 18. Compound artemisinin and metamizole tablets (复方青蒿安乃近片), Zhongganling tablets (重感灵片), and Zhongganling capsules (重感灵胶囊), which also contain metamizole, are likewise banned under 18. The measuring question uses US figures. In 2011 the US drug regulator stated that infant acetaminophen drops are 80 mg per 0.8 milliliters, and the drinkable liquid for older children is 160 mg per 5 milliliters. From those amounts, the same 1 milliliter of drops holds about 3 times as much drug as the drinkable liquid. The US drug regulator said that having both strengths at the same time is easy to mix up and can make a child take too much by accident, and that dosing devices from different products must never be mixed. A study in Greece measured 71 teaspoons and 49 tablespoons from 25 households. Filled with water, the volume ran from 2.5 milliliters to 7.3 milliliters. In a US emergency-department study, parents who used teaspoon or tablespoon units measured wrong 42.5% of the time. Parents who used only milliliters measured wrong 27.6% of the time. The adjusted OR was 2.3, 95% CI 1.2–4.4 (the chance of measuring wrong is about more than double).

Notes

Metamizole is not a first-choice drug for adults either. The leaflet says it can cause agranulocytosis (a lack of granulocytes, a class of white blood cell), aplastic anemia, and anaphylactic shock, and it is for short use only when the illness is urgent and severe and no other effective drug is available. Zhongganling (重感灵) sounds like an ordinary cold medicine, and it contains metamizole. Which fever medicine a child should take, and how much for the child's weight, is a question for a pediatrician or a pharmacist. A child under 3 months with a fever goes straight to the hospital; see section 20, item 8 (at 38 °C, go straight to the hospital). The grade is B because the Reye's syndrome figures come from surveillance reports. The drop in cases and the publication of the warning are a before-and-after relationship, not a controlled trial. The benefit is rated large because, after the warning, cases fell from 555 a year to under 36.

Sources · 6

1. Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB (1999). Reye's syndrome in the United States from 1981 through 1997. New England Journal of Medicine, 340(18):1377-1382. doi.org/10.1056/NEJM199905063401801
2. 关于加强尼美舒利口服制剂使用管理的通知（国食药监安〔2011〕209号）. nmpa.gov.cn/xxgk/fgwj/gzwj/gzwjyp/20110515145…
3. 国家药监局关于修订安乃近相关品种说明书的公告（2020年第34号）及附件1至3. nmpa.gov.cn/directory/web/nmpa/xxgk/ggtg/ypgg…
4. U.S. Food and Drug Administration. Questions and Answers – Important change in concentration for over-the-counter (OTC) liquid acetaminophen marketed for infants. fda.gov/drugs/drug-safety-and-availability/qu…
5. Falagas ME, Vouloumanou EK, Plessa E, Peppas G, Rafailidis PI (2010). Inaccuracies in dosing drugs with teaspoons and tablespoons. International Journal of Clinical Practice, 64(9):1185-1189. doi.org/10.1111/j.1742-1241.2010.02402.x
6. Yin HS, Dreyer BP, Ugboaja DC, et al. (2014). Unit of measurement used and parent medication dosing errors. Pediatrics, 134(2):e354-e361. doi.org/10.1542/peds.2014-0395