November 1997
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Necrotizing fasciitis from chickenpox.
SAN FRANCISCO - Ibuprofen may do its job too well. Recent data presented here found an association between ibuprofen's use during chickenpox and necrotizing fasciitis (NF), but stopped short of saying the drug caused the infection. Rather, researchers said, the drug may mask the symptoms signaling the onset of NF.
"Ibuprofen is effective as an antipyretic, masking inflammation and symptoms, and delaying a trip to the physician," Danielle Zerr, MD, explained here at the annual meeting of the Infectious Diseases Society of America. Zerr is a fellow at Children's Hospital and Medical Center in Seattle.
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Zerr presented data on a necrotizing fasciitis (NF) outbreak in Washington state. Between December 1993 and June 1995, 19 previously healthy children were diagnosed with NF after a primary varicella infection. This was a significant increase in pediatric NF cases in the state - there had only been two cases in the previous nine years.
Early in the outbreak, Zerr said, the high number of these children who had used ibuprofen prior to hospitalization raised concern of a possible association between ibuprofen use and NF. Investigators reviewed these cases. They also looked at 29 children who suffered a soft-tissue infection other than NF following chickenpox; these children acted as controls. For the case definition, secondary infections had to have occurred within three weeks of the primary infection.
The researchers found a higher rate of ibuprofen use among all patients. This association was not seen with acetaminophen, she added.
However, in all controls and most cases, ibuprofen was not started until after the onset of symptoms of secondary infection, such as pain and fever. "Case patients were five times more likely to use ibuprofen than controls. In most cases, this was given after onset of secondary symptoms," she said. The dose of the medication did not differ between cases and controls.
"At the time, ibuprofen was a prescription medication, and parents viewed it as a stronger medication. So did physicians," Zerr said. It is possible that because of its reputation, ibuprofen was given to sicker children with fever. By lowering fever and reducing inflammation, ibuprofen masked the beginning of the secondary symptoms, and appropriate treatment was delayed.
Zerr said a larger, prospective, multicenter study was needed before definitive recommendations could be made about ibuprofen use during varicella infection.
For more information:
- Zerr DM, Duchin JS, Rubens CE, et al. Ibuprofen as a risk factor for necrotizing fasciitis during primary varicella in children: a case-control study. Abstract #33. Presented at the 35th Annual Meeting of the Infectious Diseases Society of America. Sept. 13-16. San Francisco.
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