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A posting is making the rounds telling parents not to use ibuprofen (advil, motrin, etc) if a child has chicken pox. Unlike aspirin, which is associated with Reyes syndrome, the claim is that ibuprofen specifically can result in secondary infections of the pox. I see this even on reputable websites, as well as on more incendiary ones:

It's not clear how common secondary infection is in chickenpox.

So, should parents avoid ibuprofen if a child has chickenpox?

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An earlier warning regarding medications in children with chicken pox came to the following conclusion:

The safety of ibuprofen suspension in children. (2003) The risk of invasive Group A streptococcal infection was associated with demographic and environmental factors and persistent high fever. There was no association with the use of ibuprofen or paracetamol alone, but the use of both agents was significantly associated with streptococcal infection. These studies demonstrate that children with fever tolerate treatment with ibuprofen as well as treatment with paracetamol. Neither agent is associated with an increased risk of necrotising soft tissue infections.

But while this paper was deemed of high quality, things have changed:

NSAIDs in paediatrics: caution with varicella! (2015)

And these larger data sets now resulted in the following recommendations:

Nursing management of childhood chickenpox infection
(Boyd G, Heaton PA, Wilkinson R et al (2017) )

There has been much controversy in the media about the use of non-steroidal anti-inflammatory (NSAID) medication, such as ibuprofen, to manage fever in children with chickenpox. NICE (2016) recommends that NSAIDs should not be used in children with chickenpox due to its link to potentially life- and limb-threatening necrotising bacterial super-infection associated with group A streptococcus. A case-control study (n=140,111), undertaken in primary care in the UK, provides evidence to support this guidance (Mikaeloff et al 2008).
In summary, NSAIDs and aspirin should be avoided in patients with chickenpox, and pain and pyrexia should be controlled with reasonable alternatives, such as paracetamol (Durand et al 2015).

There are still very vocal practitioners, concluding from their professional experience and the evidence from literature, that especially in severe cases of fever iboprofen is still not strictly contra-indicated: Ibuprofen bei Varizellen nicht kontraindiziert. Although they too place paracetamol at first place for the medication of choice, they also emphasise a generally very cautious approach to previously too light heartedly prescribed medications in general.

My own conclusion from this would be to try to avoid ibuprofen, aspirin and paracetamol. If a medication of this profile – reducing pain and fever – would still and indeed be needed, than currently paracetamol – used alone – seems to win out.

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