From the Desk of Mayer Eisenstein MD,JD,MPH


Increased Risk of Death from H1N1 Flu from taking NSAIDs (aspirin, Excedrin,Ibuprofen etc.)

In This Issue
October 12, 2009
NSAIDs and FLU
Fever Flu Antipyretics
Salicylates and Pandemic Influenza Mortality
Dr Eisenstein's Comments
A Session on Vaccines
Vaccine Nation
Special offer from Our Sponsor
Dr. Eisenstein's Complementary Vaccine Webinar Series
Follow Dr. Eisenstein
Quick Links
More About Us
Our Sponsors



Article Headline

BMJ
Published 15 June 2009, doi:10.1136/bmj.b2345
Cite this as: BMJ 2009;338:b2345

NSAIDs and Flu
Rokuro Hama, chairperson1

The potentially harmful effects of non-steroidal anti-inflammatorydrugs (NSAIDs) are rarely discussed in the treatment of A/H1N1flu, which has caused high death rates in Mexico.


Severe and fatal cases, including sudden death, are characterised by severe sepsis with multi-organ failure with findings such as fever, leucocytosis, leucopenia, acute respiratory distresssyndrome (ARDS), liver impairment, renal failure, rhabdomyolysis,and hypotension.

NSAIDs may aggravate these syndromes, leading to multi-organ failure.

Since the flu pandemics of the 20th century salicylates (aspirin) have been linked to Reye's syndrome and their use restricted in children. But NSAIDs such as naproxin (Advil), aspirin (Bufferin, Bayer, Excedrin), and ibuprofen (Advil, Motrin, Nuprin), are still used as antipyretics in many countries,albeit less often than aspirin.



Since the use of NSAIDs were restricted in children in Japan in 2000,the case fatality of so called flu associated encephalopathy has fallen dramatically.

1 Japan Institute of Pharmacovigilance, 902 Ueshio3-2-17, Tennoji-ku Osaka, Japan 543-0002

BMJ 2009;339:b3050

Gina Johnson, general practitioner


...The 2007 guidelinefrom the National Institute for Health and Clinical Excellence(NICE) on feverish illness in children under 5 reviewed the sparse evidence on using antipyretic medicines, which seems to indicate that artificially lowering a fever may reduce the immune response and prolong illness. NICE therefore recommended,

"Do not routinely give antipyretic drugs to a child with fever with the sole aim of reducing body temperature."1

A small trial on the use of antipyretics in an intensive care unit was stopped because mortality was 16% in the treated group and 1% in the untreated group.2

The existing evidence suggests that antipyretics should be avoided in patients with pandemic flu,3 yet the Health Protection Agency(HPA)[ as well as the CDC, AAP, AAFP, ACOG] continues to recommend their routine use.4


1. National Institute for Health and Clinical Excellence (NICE). Feverish illness in children. Assessment and initial management in children younger than 5 years. NICE guideline 47, 2007. www.nice.org.uk/nicemedia/pdf/CG47QuickRefGuide.pdf
2. Schulman CI, Namias N, Doherty J, Manning RJ, Li P, Alhaddad A, et al. The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study. Surgical Infections 2005;6:369-75. doi: 10.1089/sur.2005.6.369[CrossRef][Medline]
3. Hama R. NSAIDs and flu. BMJ 2009;338:b2345. (15 June)
4. Health Protection Agency. Summary of prescribing guidance for the treatment and prophylaxis of influenza-like illness: treatment phase, appendix five, version 1.5, 2009. www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1243581475043

Article Headline

Salicylates and Pandemic Influenza Mortality, 1918-1919 Pharmacology, Pathology, and Historic Evidence
Clinical Infectious Diseases 2009;49:000-000

Clinical Infectious Diseases 2009;49:000-000
Karen M. M.D.

The high case fatality rate especially among young adults during the 1918-1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely "wet," sometimes hemorrhagic lungs.

The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death,

because physicians of the day were unaware that the regimens (8.0-31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate
intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance.

In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. If these recommendations were followed, and if pulmonary edema occurred in 3% of persons, a significant proportion of the deaths may be attributable to aspirin.

Article Headline
Dr. Eisenstein's Comments:

This evidence from The British Medical Journal shows that antipyretics such as Tylenol, aspirin (Bufferin, Bayer, Excedrin), ibuprofen (Advil, Motrin, Nuprin), ketoprofen (Actron, Orudis), and naproxen (Aleve), should not be given for any type of flu and may be responsible for many of the deaths associated with the H1N1 Flu.


In 1918, the
the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. This recommendation may have been responsible for a significant proportion of the deaths.

My recommendations:

1. Vitamin D levels greater than 60ng/ml
2. No aspirin, Tylenol, Aleve etc. for fever
3. Lots of fluids and chicken soup
4. And "NO" Swine or Seasonal flu vaccines