• Skip to main content
  • Skip to primary sidebar
  • Home
  • News
  • Education
  • Events
  • Interviews
    • Career spotlight
  • Opinion
    • Professional Dilemmas
    • Patient perspective
  • PIPcast
  • Jobs
  • Business Directory

Pharmacy in Practice

EDX/20/1154
Date of prep: December 2020

Prescribing information and
adverse events reporting

For healthcare professionals only

COVID-19 should drive a renaissance of pragmatism

28th March 2020 by PIP editor Leave a Comment

 

As the COVID-19 pandemic gains momentum, we’re all going to find ourselves either much busier or stuck at home. Over the next few weeks, I intend to publish a series of short articles, to provide some coffee break sized learning for clinicians on the front line.

 

If you have any COVID questions of your own, please send them to me.

 

These posts will not be heavily referenced, if at all. We are in the very early stages of gathering evidence and the risk with early evidence is that it can be very misleading for various reasons.

 

Much of what is coming out from this crisis is a renaissance of pragmatism.

 

That pragmatism is born out of necessity but is based in the common sense and experience of the clinicians who look after children. Together we can figure out what’s truly important and cut through the evidence, without ignoring it.

 

The first question is as follows…

 

Should we recommend the use of ibuprofen for symptomatic relief in a child with a respiratory tract infection?

 

France’s health minister, Olivier Véran created a great deal of anxiety for both clinicians and the public when he said that people should avoid using ibuprofen because it may make COVID-19 infection worse. This prompted a variety of responses from organisations around the world.  Some recommended against using ibuprofen and some stated that there was no evidence that it made COVID-19 infection worse.

 

Why was there such a disparity of recommendations? 

 

The answer is that your view will depend on your perspective.

 

Is there a possibility that ibuprofen could make COVID-19 infection worse? 

 

Yes.

 

There is a hypothetical risk because the anti-inflammatory properties of ibuprofen include some elements of the immune response.

Is there any evidence that this biochemical effect has any clinical effect? 

 

No.

 

There is no clinical evidence that ibuprofen actually makes COVID-19 infection worse.

 

So with hypothetical harm and no evidence that it is real, what should you recommend? 

 

That depends on whether you think that being able to take ibuprofen is important. If not, then you may as well avoid it. I would argue that there are plenty of reasons to think that avoiding the use of ibuprofen is harmful in children with respiratory tract infection.

 

It is arguable that the single greatest risk of avoiding Ibuprofen is unnecessary exposure to infection.

 

Children with uncomplicated respiratory tract infections are best managed symptomatically. Although parents often seek a clinical assessment, this rarely adds anything other than reassurance in the child who has no respiratory distress, signs of sepsis or dehydration. In normal circumstances, the clinical assessment itself is low risk. These times are not normal circumstances.

 

Any healthcare setting is currently extremely high risk for acquiring COVID-19 infection, so anything that brings you to the doors of a hospital or community clinical environment is itself dangerous.

 

It, therefore, follows that anything that avoids this attendance is protective.

 

Analgesia is a good way of helping a child with a respiratory tract infection to feel well and behave in a way that lets the parent know that they are not dangerously unwell. It is also a good way to give the child the best possible chance of hydrating orally, by resolving their sore throat, sore ear or general malaise.

 

It is interesting that the initial flurry of recommendations against the use of ibuprofen was followed by a steady stream of statements that there was no evidence for such avoidance and a series of retractions and clarifications. I think that the about-turn was brought about by an alliance of evidence-based medicine purists and front-line pragmatists who recognised that symptomatic relief is under-rated and has a genuinely important role in these times.

 

Even if you have genuine anxieties about the use of ibuprofen in children with potential COVID-19 infection, I would suggest the following principle:

 

 

While avoiding ibuprofen may feel safe, my opinion is that ibuprofen may be useful as a way to keep children and the adults who care for them safe by avoiding unnecessary clinical contact.

 

Edward Snelson

@sailordoctor

 

You can check out Edward’s excellent blog by clicking here.

 

 

 

 

Share this:

  • Click to share on LinkedIn (Opens in new window)
  • Click to share on Facebook (Opens in new window)
  • Click to share on Twitter (Opens in new window)
  • Click to share on WhatsApp (Opens in new window)
  • Click to share on Telegram (Opens in new window)
  • Click to email this to a friend (Opens in new window)

Related

Filed Under: Education Tagged With: Blogs, Coronavirus

Register for our upcoming webinar and live Q&A

About PIP editor

Pharmacy in Practice is a UK pharmacy publication with its roots in Scotland.

Reader Interactions

Begin the discussion right here Cancel reply

Primary Sidebar

Categories

Follow Us

  • Twitter
  • LinkedIn
  • Facebook
  • Instagram
  • Twitter

PIP business directory

Letters to the editor

Letters to the editor

Pharmacies should be allowed to supply rapid antibody tests

The ‘ART’ of Scottish community pharmacy is all about data

Is a pharmacist who sells rapid antibody tests unfit to practise?

We need to talk about alcoholism in pharmacy

More letters to the editor here...

Blogs

💊 PIP live pharmacy blog

Winter stresses must not ‘destabilise’ general practice

What is it like to depend on medicine to treat endometriosis?

Opinion

Why is pharmacy not integral to government mass vaccination plans?

Pharmacy Covid-19 vaccination involvement is a ‘no-brainer’

The great patient medication returns debacle

CPD Challenges

💊 CPD Challenge: How well do you understand pulmonary embolisms?

💊 CPD Challenge: Prescribing and dispensing clozapine

💊 CPD Challenge: Oral anticoagulants – Dabigatran

More CPD challenges here...

© 2021 · About Pharmacy In Practice · Site mantained by Mike

This site is for healthcare professionals, please confirm you are a healthcare professional to continue.

YES

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
Pharmacy In Practice uses cookies, by continuing to use this site we will assume you are ok with that Find out more.