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A meta-analysis by Goldstein and colleagues1 nicely summarized that rectal acetaminophen can reduce fever, and though it is not believed to alter the course of infectious illness, we can assume it provides symptomatic relief. However, we find their call for the American Academy of Pediatrics to revise their recommendations pertaining to rectal acetaminophen in children to be premature, and their suggestion for more studies “evaluating possible pharmacodynamic differences in toxic effects between oral and rectal acetaminophen” to be slightly misplaced.
We believe that the mechanisms of toxicity for orally and rectally administered acetaminophen to be similar but that the patients receiving these formulations are inherently different. Acetaminophen suppositories are typically reserved for vomiting calorie-deprived children, a group that has been proposed to potentially be at a higher risk of toxicity due to glutathione depletion. Prescribing patterns for rectal acetaminophen, and risk factors for increased susceptibility to its toxic effects, merit further study. It is interesting that many of the case reports of pediatric acetaminophen hepatotoxicity from the 1980s and 1990s described repeated overdoses with suppositories and that the use of rectal suppositories has been shown to have an odds ratio of 4.9 (95% confidence interval, 2.32-10.23) with regard to administration of higher-than-recommended dosing.2
The American Academy of Pediatrics' recommendation does not preclude suppository administration, but states that “rectal acetaminophen therapy should be avoided unless specifically discussed with the health care provider and that directions be followed.”3 That recommendation still seems prudent.
Correspondence: Dr Osterhoudt, The Poison Control Center at The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 (osterhoudtk@email.chop.edu).
Author Contributions:Study concept and design: Osterhoudt and Henretig. Drafting of the manuscript: Osterhoudt. Critical revision of the manuscript for important intellectual content: Henretig. Administrative, technical, and material support: Osterhoudt. Study supervision: Henretig.
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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