Painkillers linked to fatal disease in children

PUBLISHED : Wednesday, 30 April, 2008, 12:00am
UPDATED : Wednesday, 30 April, 2008, 12:00am

A leading hospital pharmacist has warned doctors to beware when giving painkillers to feverish children as the medicines might trigger a deadly flu-related brain disease.

A young boy died of the disease last month and another boy may have been a victim this month.

An expert panel concluded that Law Ho-ming, who died in Tuen Mun Hospital on March 11, had suffered flu-related acute necrotising encephalopathy.

The brain disease is 'characterised by fever, a rapid alteration in consciousness, and seizures', according to an article in the Paediatric Infectious Disease Journal, which described the first such case to be identified in the United States in 2004.

The brain disease has been widely recognised in recent years in Asia, including Japan and Taiwan, possibly because of the common practice of doctors prescribing drugs known by their generic names, mefenamic acid and diclofenac sodium, said William Chui Chun-ming, the education director of the Society of Hospital Pharmacists.

He said it was possible that similar medicines were prescribed to 11-year-old Ho Sze-chung, who died on April 23 in Prince of Wales Hospital.

Ponstan is the most widely prescribed drug containing mefenamic acid and is usually taken for menstrual pain. Voltaren was the most popular brand of diclofenac sodium, which was used for treating osteoarthritis and rheumatoid arthritis, Mr Chui said.

Yet private paediatricians in Hong Kong prescribed both drugs for children under five, which was a dangerous thing to do, he said.

'That is why the risk increases of developing acute necrotising encephalopathy,' he said. 'Children suffering from influenza produce cytokines, which can modify the characteristics of the blood-brain barrier,' he said.

'This then allows more of the drugs to go into the brain directly,' he said, citing clinical evidence in published papers by Japanese doctors.

Mr Chui called on the Hospital Authority and the Department of Health to release the full report of the expert panel, headed by Yuen Kwok-yung, a flu expert at the University of Hong Kong.

A failure to do so would deprive people of vital health information that could prevent similar tragedies in the future.

He said the safest medicine to give young children with fever was paracetamol, and a warm water bath to lower their body temperature.

In response to questions about Sze-chung, a spokeswoman at the Department of Health said: 'Acute encephalopathy is not a common disease in children and definitive causes may not be established in many patients with encephalitis or encephalopathy despite extensive testing and investigation, as revealed by overseas studies.

'A postmortem was conducted. Results of relevant tests are pending. The case has been referred to the coroner's court.'

An expert panel was set up to investigate the cases of three children who died last month because their deaths occurred during the peak flu season, she said.

Meanwhile, five reports were received yesterday of flu-like outbreaks affecting 38 people at a home for the elderly, three primary schools and a childcare centre.

About 286,700 people including young children who are chronically ill or on welfare have been vaccinated under a government flu programme that ends today.