Pediatric Fatalities Associated With Over the Counter (Nonprescription) Cough and Cold Medications

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• 作者：Richard C. Dart ; Ian M. Paul ; G. R ; all Bond ; David C. Winston ; Anthony S. Manoguerra ; Robert B. Palmer ; Ralph E. Kauffman ; William Banner ; Jody L. Green ; Barry H. Rumack
• 刊名：Annals of Emergency Medicine
• 出版年：2009
• 出版时间：April 2009
• 年：2009
• 卷：53
• 期：4
• 页码：411-417
• 全文大小：410 K

文摘

Study objective

The use of nonprescription cough and cold medicines is widespread, but their use has been sporadically associated with severe toxicity and death. We evaluate the role of these medications in pediatric fatalities and identified factors that contributed to the death.

Methods

Fatalities that involved a child younger than 12 years and mentioned a cough and cold ingredient were obtained from 5 sources. An independent panel of 8 experts (pediatrics, pediatric critical care, pediatric toxicology, clinical toxicology, forensic toxicology, forensic pathology) used explicit definitions to assess the causal relationship between medication ingestion and death. Contributing factors were identified.

Results

Of 189 cases included, 118 were judged possibly, likely, or definitely related to a cough and cold ingredient. Of these 118 cases, 103 involved a nonprescription drug, whereas 15 cases involved a prescription medication alone. Of 103 cases associated with nonprescription drugs, the evidence indicated that 88 involved an overdosage. A dosage could not be assessed in the remaining 15 cases. Several contributing factors were identified: age younger than 2 years, use of the medication for sedation, use in a daycare setting, use of 2 medicines with the same ingredient, failure to use a measuring device, product misidentification, and use of a nonprescription product intended for adult use. All cases that occurred in a daycare setting involved a child younger than 2 years.

Conclusion

In our sample, pediatric fatalities caused by nonprescription cough and cold medications were uncommon, involved overdose, and primarily affected children younger than 2 years. The intent of caregivers appears to be therapeutic to relieve symptoms in some cases and nontherapeutic to induce sedation or to facilitate child maltreatment in other cases.