When “fever” meets “new coronavirus pneumonia”, how to choose antipyretic drugs?

The Daily Mail reported that a 4-year-old girl showed symptoms of new coronavirus infection. Her father gave her ibuprofen, but the symptoms did not ease but worsened. One hour after taking ibuprofen, the little girl's temperature rose to 39.4℃, and she developed symptoms such as increased heart rate and body tremors. She was sent to the hospital for antipyretic treatment in time and her fever was relieved.

1. Does ibuprofen make COVID-19 symptoms worse?

There is still a lack of sufficient clinical evidence that ibuprofen can worsen COVID-19 symptoms. The WHO's warning also mentioned that research on the relationship between ibuprofen and COVID-19 infection is still ongoing, and further instructions will be given based on the research results. However, based on the relevant cases and warnings from relevant countries and institutions, if suspected symptoms of COVID-19 infection occur, people should try to avoid taking ibuprofen and other non-steroidal anti-inflammatory analgesics with anti-inflammatory effects.

Ibuprofen is a non-steroidal anti-inflammatory drug with anti-inflammatory effects. It inhibits the biosynthesis of COX enzymes in the body and reduces the production of prostaglandins and the release of inflammatory factors, thereby achieving antipyretic, analgesic and anti-inflammatory effects. Since the anti-inflammatory effect of ibuprofen is achieved by reducing the synthesis of prostaglandins, the anti-inflammatory effect of ibuprofen actually slightly inhibits the body's immune response system. In fever caused by ordinary inflammation, this mild inhibitory effect can relieve symptoms without aggravating the condition; and in the process of new coronavirus infection, the impact of ibuprofen on the body's immune system may lead to the aggravation of new coronavirus infection.

A recent study in the British academic journal The Lancet also proposed a related hypothesis, stating that ibuprofen would increase the level of angiotensin-converting enzyme 2 (ACE2), which is the binding site for the coronavirus COVID-19 to infect human cells. Therefore, the article speculates that ibuprofen may increase the risk of infection and the condition of COVID-19 by increasing the level of ACE2.

2. Which antipyretic drug should be used by patients or suspected patients with COVID-19?

Regarding the new coronavirus infection, the World Health Organization has issued a new medication warning: If you have symptoms such as fever and cough related to COVID-19, do not take the non-steroidal anti-inflammatory drug ibuprofen on your own.

The French Minister of Health recommends: In the case of uncertainty as to whether ibuprofen can aggravate the symptoms of COVID-19, it is recommended to take acetaminophen if fever symptoms occur.

3. Can ibuprofen be used for fever caused by common pneumonia or cold?

Fever is a manifestation of disease, a symptom rather than an independent disease. WHO and FDA recommend the use of antipyretics when children feel uncomfortable and depressed due to fever. Common antipyretics for children are acetaminophen or ibuprofen. Oral acetaminophen is recommended for children aged 2 months and above, and acetaminophen or ibuprofen is recommended for children aged 6 months and above. Both can be chosen for fever caused by the common cold or pneumonia. Ibuprofen is only for short-term use when used for fever and should not be used by oneself for more than 3 days.

4. What should we do if we develop a fever during the special period of COVID-19?

First of all, if conditions permit and you take good protective measures, go to the fever clinic and ask a professional doctor for diagnosis and treatment. If conditions are not met, WHO experts recommend acetaminophen, which has no anti-inflammatory effect and is safer than anti-inflammatory drugs such as ibuprofen in the case of new coronavirus infection.

References

[1] Foreign media: The World Health Organization recommends not taking the anti-inflammatory drug ibuprofen when experiencing symptoms of COVID-19 infection. Xinhua News Agency. March 20, 2020.