Karami Sara, Asonye Cooma, Pinnow Ellen, Pratt Valerie, McCulley Lynda, Dwumfour Nana, Zhou Esther H
Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA.
Clin Toxicol (Phila). 2023 Mar;61(3):190-199. doi: 10.1080/15563650.2022.2158847. Epub 2023 Mar 9.
To examine pediatric exposure trends involving selected nonprescription analgesics/antipyretics, before and during the COVID-19 pandemic.
Using descriptive and interrupted time-series analyses, we assessed monthly United States poison center data involving pediatric (<18 years) exposures to nonprescription paracetamol (acetaminophen), ibuprofen, acetylsalicylic acid, and naproxen before (January 2015-February 2020) and during (March 2020-April 2021) the pandemic. Statins and proton pump inhibitors (prescription or nonprescription) served as controls.
Most nonprescription analgesic/antipyretic exposures (75-90%) were single-substance; unintentional exposures typically involved children <6 years (84-92%), while intentional exposures involved females (82-85%) and adolescents, 13-17 years (91-93%). Unintentional exposures among children <6 years, declined for all four analgesics/antipyretics immediately after the World Health Organization declared COVID-19 a pandemic (March 11, 2020), but most significantly for ibuprofen (30-39%). Most intentional exposures were classified as suspected suicide. Intentional exposures were relatively low and stable among males. Intentional exposures in females declined immediately after the pandemic was announced but subsequently increased to pre-pandemic levels for acetylsalicylic acid and naproxen and above pre-pandemic levels for paracetamol and ibuprofen. For paracetamol, female intentional exposures increased from 513 average monthly cases in the pre-pandemic to 641 average monthly cases during the pandemic; and reached 888 cases by the end of the study period in April 2021. While for ibuprofen, average monthly cases rose from 194 in the pre-pandemic, to 223 during the pandemic; and reached 352 cases in April 2021. Patterns were similar among females 6-12 and 13-17 years.
Nonprescription analgesic/antipyretic unintentional exposure cases declined among young children, while intentional exposure cases increased among females, 6-17 years, during the pandemic. Findings highlight the importance of safely storing medications and being alert to signs that adolescents may be in need of mental health support services; caregivers should seek medical care or call poison control centers for any suspected poisoning event.
研究新冠疫情之前及期间，儿童接触特定非处方镇痛药/退热药的趋势。
我们采用描述性分析和中断时间序列分析方法，评估了美国毒物控制中心的月度数据，这些数据涉及疫情之前（2015年1月至2020年2月）及期间（2020年3月至2021年4月）18岁以下儿童接触非处方对乙酰氨基酚、布洛芬、乙酰水杨酸和萘普生的情况。他汀类药物和质子泵抑制剂（处方或非处方）作为对照。
大多数非处方镇痛药/退热药暴露情况（75%-90%）为单一物质暴露；无意暴露通常涉及6岁以下儿童（84%-92%），而有意暴露涉及女性（82%-85%）和13至17岁青少年（91%-93%）。在世界卫生组织宣布新冠疫情为大流行（2020年3月11日）后，所有四种镇痛药/退热药在6岁以下儿童中的无意暴露量均下降，其中布洛芬下降最为显著（30%-39%）。大多数有意暴露被归类为疑似自杀。男性的有意暴露量相对较低且稳定。疫情宣布后，女性的有意暴露量立即下降，但随后乙酰水杨酸和萘普生的有意暴露量回升至疫情前水平，对乙酰氨基酚和布洛芬的有意暴露量则高于疫情前水平。对于对乙酰氨基酚，女性有意暴露量从疫情前的平均每月513例增至疫情期间的平均每月641例；到2021年4月研究期结束时达到888例。而对于布洛芬，平均每月病例数从疫情前的194例增至疫情期间的223例；2021年4月达到352例。6至12岁和13至17岁女性的情况类似。
疫情期间，幼儿非处方镇痛药/退热药的无意暴露病例减少，而6至17岁女性的有意暴露病例增加。研究结果凸显了安全储存药物以及警惕青少年可能需要心理健康支持服务迹象的重要性；护理人员应就任何疑似中毒事件寻求医疗护理或致电毒物控制中心。
