Counterculture 42: Coughs and colds
At the OTC Pharmacy, a woman has asked medicines counter assistant Anna for a 200ml pack of a brand of paracetamol suspension that is a P-medicine and is kept behind the counter. From asking the WWHAM questions, Anna establishes that the woman has bought the product before and is buying it as a standby for her three children for treating pain and for raised temperature associated with colds and other minor childhood infections. As Anna hands over the product, she also gives the woman a printed sheet.
"What's this for?" the woman asks.
Anna replies: "I was just about to explain. There's recently been a government recommendation about doses of paracetamol for children.
They are a bit different from the dosages currently printed on packs, so until we get new stocks with the recommended new dosages on we're giving out these sheets to explain the situation. They also set out the new doses."
The woman looks a bit alarmed. "Does that mean that the doses on the pack here aren't safe?"
"No, not at all," replies Anna. "The leaflet explains exactly why the new recommendations have been made."
Later that day, a woman asks Anna for a bottle of paracetamol suspension and a bottle of ibuprofen suspension. When Anna asks why she wants both, the woman replies:"My neighbour's a nurse and told me that if you give alternate doses of each it's better at reducing high temperature in children than either on its own."
Questions
1 Why have changes been made to the recommended doses of paracetamol for children?
2 How do the doses differ from those recommended previously?
3 What exactly are the new doses?
4 Are alternate doses of paracetamol and ibuprofen suspensions more
effective at reducing temperature in children than either alone?
Answers
1 The Medicine and Healthcare products Regulatory Agency (MHRA), which is responsible for ensuring the safety and effectiveness of medicines, has updated dosing for children's liquid medicines containing paracetamol to ensure they get the most effective amount for their age. The change is not because of safety concerns and dosages printed on current packs are safe.
2 The updated dosing has a larger number of narrower age bands and gives a single dose for each age band.
3 For 120mg/5ml (infant) suspension – three to six months old: 2.5ml (60mg); six months to two years: 5ml (120mg); two to four years: 7.5ml (180mg); four to six years: 10ml (240mg). For 240mg/5ml (6+/junior) suspension – six to eight years: 5ml (240mg); eight to 10 years: 7.5ml (360mg); 10-12 years: 10ml (480mg). All doses remain at four-hourly intervals to a maximum of four doses daily.
4 A research article in the British Medical Journal (BMJ 2008;337:a1302) found alternate doses of paracetamol and ibuprofen suspensions did reduce temperature in children more quickly and keep it slightly lower over 24 hours than either alone. However, it also recommended ibuprofen alone should be used first and paracetamol tried only if ibuprofen was not effective. Official NHS advice recommends children should not normally be given the two medicines together.
When should you involve the pharmacist?
Children's coughs, particularly, if they are persistent, are always worth deeper investigation. When a woman asked at the medicines counter for something for her six-year-old son's dry cough that he has had on and off for a couple of weeks, the counter staff at OTC Pharmacy rightly referred the mum to Dee, the pharmacist. After asking the woman some questions, Dee suggested that she take her son to see their GP.
A month later the woman returned to see Dee. She said that the doctor had examined the boy and thought that the cough might be left over from a cold he had had, and that it would probably clear up on its own. She didn't prescribe anything. The cough had tailed off for a while, but it was back again now.
In response to further questions from Dee, the woman said that her son only seemed to cough at night. She had tried a children's cough suppressant, but it hadn't really helped. He was not having any pain or difficulty with his breathing, or any shortness of breath. Dee asked whether the boy had eczema, or if anyone in the family had eczema, asthma or allergic conditions such as hayfever. The woman replied that her son did not have eczema, but her husband did suffer from hayfever in the summer.
Dee thought that the boy's symptoms could suggest asthma, an auto-allergic condition that was often linked with eczema, hayfever or a family connection with this type of condition. But a cough as a result of bronchial irritation following a cold can last for up to six weeks, so the GP's diagnosis could be right. Dee advised the woman to go back to the GP and ask her to check the boy for asthma.
