Don't use aspirin, nimesulide (尼美舒利) or metamizole (安乃近) for a child's fever, and don't give minors cold medicines that contain metamizole

Cost

Free. When you buy a fever reducer, look at the generic name and the ingredient list.

What you get

Reye's syndrome causes brain disease and fatty change in the liver, and usually appears after influenza or chickenpox. In U.S. national surveillance from 1981 to 1997, 1207 cases were reported in people under 18. In 82% of the children, salicylate, an ingredient of aspirin-type drugs, was detected in the blood. The overall case fatality rate was 31%. Warnings about salicylates began in 1980. That year 555 cases were reported, the peak, and from 1987 on there were no more than 36 a year. In 2011 the China Food and Drug Administration (国家食药监局) ruled that oral nimesulide preparations may not be used in children under 12. In 2020 the National Medical Products Administration (国家药监局) ruled that metamizole tablets are banned for adolescents and children under 18. The metamizole-containing Compound Qinghao Anaijin Tablets (复方青蒿安乃近片), Zhonggan Ling Tablets (重感灵片) and Zhonggan Ling Capsules (重感灵胶囊) are likewise banned under 18.

Notes

Metamizole (安乃近) is not a first choice for adults either. The inserts state that it can cause agranulocytosis, aplastic anemia and anaphylactic shock, and it is to be used briefly only when the condition is acute and serious and no other effective drug is available. Zhonggan Ling (重感灵) sounds like an ordinary cold medicine, but it contains metamizole. Ask a pediatrician or pharmacist what fever reducer to use for a child and how much to give by weight. For a child under 3 months with a fever, go straight to the hospital; see §20.8 (go straight to the hospital at 38 ℃). Graded B because the Reye's syndrome numbers come from surveillance reports, and the fall in cases followed the warning in time but was not a controlled trial. The benefit is rated “large” because after the warning cases fell from 555 a year to 36 or fewer.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Belay ED, Bresee JS, Holman RC, Khan AS, Shahriari A, Schonberger LB (1999). Reye's syndrome in the United States from 1981 through 1997. New England Journal of Medicine, 340(18):1377-1382. https://doi.org/10.1056/NEJM199905063401801
2. 关于加强尼美舒利口服制剂使用管理的通知（国食药监安〔2011〕209号）. https://www.nmpa.gov.cn/xxgk/fgwj/gzwj/gzwjyp/20110515145101552.html
3. 国家药监局关于修订安乃近相关品种说明书的公告（2020年第34号）及附件1至3. https://www.nmpa.gov.cn/directory/web/nmpa/xxgk/ggtg/ypggtg/ypshmshxdgg/20200317171201660.html

Translated from the Chinese original. Original book, section 34, tip 2. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer