Trends in pediatric nonprescription analgesic/antipyretic exposures during the COVID-19 pandemic

Abstract

Objective

To examine pediatric exposure trends involving selected nonprescription analgesics/antipyretics, before and during the COVID-19 pandemic.

Methods

Using descriptive and interrupted time-series analyses, we assessed monthly United States poison center data involving pediatric (<18 years) exposures to nonprescription paracetamol (acetaminophen), ibuprofen, acetylsalicylic acid, and naproxen before (January 2015-February 2020) and during (March 2020-April 2021) the pandemic. Statins and proton pump inhibitors (prescription or nonprescription) served as controls.

Results

Most nonprescription analgesic/antipyretic exposures (75–90%) were single-substance; unintentional exposures typically involved children <6 years (84–92%), while intentional exposures involved females (82–85%) and adolescents, 13–17 years (91–93%). Unintentional exposures among children <6 years, declined for all four analgesics/antipyretics immediately after the World Health Organization declared COVID-19 a pandemic (March 11, 2020), but most significantly for ibuprofen (30–39%). Most intentional exposures were classified as suspected suicide. Intentional exposures were relatively low and stable among males. Intentional exposures in females declined immediately after the pandemic was announced but subsequently increased to pre-pandemic levels for acetylsalicylic acid and naproxen and above pre-pandemic levels for paracetamol and ibuprofen. For paracetamol, female intentional exposures increased from 513 average monthly cases in the pre-pandemic to 641 average monthly cases during the pandemic; and reached 888 cases by the end of the study period in April 2021. While for ibuprofen, average monthly cases rose from 194 in the pre-pandemic, to 223 during the pandemic; and reached 352 cases in April 2021. Patterns were similar among females 6–12 and 13–17 years.

Conclusion

Nonprescription analgesic/antipyretic unintentional exposure cases declined among young children, while intentional exposure cases increased among females, 6–17 years, during the pandemic. Findings highlight the importance of safely storing medications and being alert to signs that adolescents may be in need of mental health support services; caregivers should seek medical care or call poison control centers for any suspected poisoning event.

Keywords:

• Nonprescription
• analgesics and antipyretics
• children
• exposures
• COVID-19 pandemic

Acknowledgments

The authors thank you to Drs. Patty Greene, Monique Falconer, Kira Leishear, Andrew Mosholder, Jae Wook Yoo, Tamra Meyer, Amarilys Vega, and Gerald Dal Pan for their review of the manuscript, and valuable suggestions and comments.

Disclaimer

America’s Poison Centers maintains the National Poison Data System (NPDS), which houses de-identified records of self-reported information from callers to the country's Poison Centers (PCs). NPDS data do not reflect the entire universe of US exposures and incidences related to any substance(s). Exposures do not necessarily represent a poisoning or overdose and America's Poison Centers is not able to completely verify the accuracy of every report. NPDS data do not necessarily reflect the opinions of America’s Poison Centers.

Authors contributions

Drs Karami and Zhou conceptualized and designed the study, analyzed the data, drafted the manuscript, and revised the manuscript. Dr Asonye conceptualized the study, extracted the data, carried out the initial analyses and quality control, and revised the manuscript. Drs Pinnow, Pratt, and McCulley conceptualized the study, participated in interpretation of data, and revised the manuscript. Dr Dwumfour provided consultation on nonprescription data sources; participated in the design and interpretation of data; and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of their work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

No funding was secured for this study. This work was supported by the US Food and Drug Administration. The views in this article are those of the authors and not necessarily those of the US Food and Drug Administration.