Manley Jennifer, Taddio Anna
Graduate Department of Pharmaceutical Sciences, University of Toronto, Ontario, Canada.
Ann Pharmacother. 2007 Jul;41(7):1227-32. doi: 10.1345/aph.1H647. Epub 2007 May 22.
To evaluate the literature examining prophylactic use of acetaminophen and ibuprofen for prevention of adverse reactions associated with childhood immunization.
Articles were identified via MEDLINE/PubMed/EMBASE (1966-March 2007) using the following key terms: vaccination, immunization, diphtheria-tetanus toxoids-whole pertussis (DTwP), diphtheria tetanus-toxoid, whole pertussis, diphtheria-tetanus toxoids-acellular pertussis (DTaP), acellular pertussis, Haemophilus influenzae type B, inactivated poliovirus, pneumococcal 7-valent conjugate, measles, mumps, rubella, meningococcal C-conjugate, varicella zoster, hepatitis B, influenza, pneumococcal polysaccharide, adverse reactions, analgesics, antipyretics, acetaminophen, ibuprofen, infant, and child.
No limitations were placed on article selection.
Five articles examining the effects of prophylactic acetaminophen or ibuprofen for adverse effects associated with either DTaP or DTwP vaccine were retrieved. In one randomized controlled trial of children aged 4-6 years given DTaP, no effect of prophylactic acetaminophen 15 mg/kg/dose, up to 450 mg, or ibuprofen 10 mg/kg/dose, up to 300 mg, was found on the incidence of fever, redness, pain, swelling, or itching. In 3 randomized studies of DTwP, either acetaminophen 10-15 mg/kg/dose or ibuprofen 20 mg/kg/24 hours, given in 3 equal doses before or at the time of immunization and every 4-8 hours thereafter for 12 or more hours, reduced fever, pain, fussiness, and local redness in infants 2-7 months of age compared with placebo. Results were not duplicated in older infants/children. No studies investigated use of prophylactic acetaminophen or ibuprofen for any other vaccine.
Use of prophylactic acetaminophen and ibuprofen may reduce the incidence of adverse reactions in young infants receiving DTwP vaccine; however, DTwP has been replaced with DTaP, and no benefits have been demonstrated for this vaccine when evaluated in children aged 4-6 years, or with any other vaccine currently in use. Thus, neither drug can be recommended prophylactically to prevent vaccine-associated adverse reactions. Individuals at high risk for seizures may, however, warrant special consideration.
评估关于对乙酰氨基酚和布洛芬预防性使用以预防儿童免疫接种相关不良反应的文献。
通过MEDLINE/PubMed/EMBASE（1966年 - 2007年3月）检索文章，使用以下关键词：疫苗接种、免疫接种、白喉 - 破伤风类毒素 - 全细胞百日咳（DTwP）、白喉破伤风类毒素、全细胞百日咳、白喉 - 破伤风类毒素 - 无细胞百日咳（DTaP）、无细胞百日咳、B型流感嗜血杆菌、灭活脊髓灰质炎病毒、7价肺炎球菌结合疫苗、麻疹、腮腺炎、风疹、C群脑膜炎球菌结合疫苗、水痘带状疱疹、乙型肝炎、流感、肺炎球菌多糖、不良反应、镇痛药、退热药、对乙酰氨基酚、布洛芬、婴儿和儿童。
文章选择无限制。
检索到5篇研究对乙酰氨基酚或布洛芬预防性使用对DTaP或DTwP疫苗相关不良反应影响的文章。在一项针对4 - 6岁儿童接种DTaP的随机对照试验中，未发现预防性使用15mg/kg/剂量（最高450mg）的对乙酰氨基酚或10mg/kg/剂量（最高300mg）的布洛芬对发热、发红、疼痛、肿胀或瘙痒的发生率有影响。在3项关于DTwP的随机研究中，在免疫接种前或接种时给予对乙酰氨基酚10 - 15mg/kg/剂量或布洛芬20mg/kg/24小时，分3等份给药，之后每4 - 8小时给药一次，持续12小时或更长时间，与安慰剂相比，可降低2 - 7个月龄婴儿的发热、疼痛、烦躁和局部发红。在较大婴儿/儿童中未重复出现该结果。没有研究调查对乙酰氨基酚或布洛芬预防性使用对任何其他疫苗的影响。
预防性使用对乙酰氨基酚和布洛芬可能会降低接种DTwP疫苗的幼儿中不良反应的发生率；然而，DTwP已被DTaP取代，在4 - 6岁儿童中评估该疫苗或目前使用的任何其他疫苗时，未显示出益处。因此，不建议预防性使用这两种药物来预防疫苗相关不良反应。然而，癫痫发作高风险个体可能需要特别考虑。
