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фенирамина малеатэто C20H24N2O4, а хлорфенирамин — C16H19ClN2
Это — первое рандомизированное контролируемое исследование
Самой лучшей защиты против гриппозной инфекции является вакцинация
BACKGROUND AND OBJECTIVE:
Anti-pyretic treatment is recommended in the management of influenza infection. In animal models anti-pyretic treatment increases mortality from influenza. We investigated the effects of paracetamol on viral and clinical outcomes in adults with influenza infection.
METHODS:
This is a randomized, double-blind, placebo-controlled trial of adults aged 18-65 years with influenza-like illness and positive influenza rapid antigen test. Treatments were 1 g paracetamol four times a day, or matching placebo, for 5 days. Pernasal swabs were taken for influenza quantitative RT-PCR at Baseline and Days 1, 2 and 5. Temperature and symptom scores were recorded for 5-14 days or time of resolution respectively. The primary outcome variable was area under the curve (AUC) for quantitative PCR log10 viral load from Baseline to Day 5.
RESULTS:
A total of 80 participants were randomized: no one was lost to follow up, and one withdrew after 4 days. There were 22 and 24 participants who were influenza PCR-positive in placebo and in paracetamol groups respectively. Mean (SD) AUC PCR log10 viral load was 4.40 (0.91) in placebo and 4.64 (0.88) in paracetamol; difference was -0.24, 95% CI: -0.78 to 0.29, P = 0.36. In all participants there were no differences in symptom scores, temperature, time to resolution of illness and health status, with no interaction between randomized treatment and whether influenza was detected by PCR.
CONCLUSION:
Regular paracetamol had no effect on viral shedding, temperature or clinical symptoms in patients with PCR-confirmed influenza. There remains an insufficient evidence base for paracetamol use in influenza infection.
CLINICAL TRIAL REGISTRATION:
ACTRN12611000497909 at the Australian New Zealand Clinical Trials Registry.
Небольшое, но с нормальным дизайном исследование, не в самом крутом журнале, однако это очередное очко не в пользу парацетамола при гриппе (как минимум), а то и при всех ОРВИ. Строго говоря, об этом говорится давно — препарат-то не самый безопасный, лидер по лекарственным гепатитам, однако. Суточную дозировку уже сколько раз пересматривали в сторону уменьшения, ну и т.д. Плюс его включают во все сиропы, порошки для приготовления горячего питья и прочие комбинированные средства «от простуды». И редко кто из пациентов считает весь парацетамол, которые он за сутки съедает в разных формах.… скармливали 3 дня подряд по 1,75 максимальной суточной дозы!
Не торопитесь сбивать поднявшуюся до 37,5-38°С температуру, это, как принято говорить, НОРМА! И бороться с ней нужно, когда она из защитной реакции превращается в нападательную.…
Если говорить о жаропонижающих, то парацетамол и ибупрофен в этой роли — так себе, оба два. При этом первый, как уже говорилось, бьет по печени, второй — по слизистой ЖКТ…
Не старайтесь сбивать температуру в ноль. Снижение на 1-1,5°С зачастую вполне достаточно (ориентир — около 38°С).
“We do not know why acetaminophen had no effect on pain in our study,” Braithwaite said.
A single study in a sample consisting mainly of otherwise healthy young adults is not enough to draw generalized conclusions about the effect of acetaminophen on the flu for everyone, she said.
“What this study does is raise some very serious questions about the real evidence base for using acetaminophen routinely for anyone that has the flu,” she said.
All the patients were also taking daily doses of the antiviral medication Tamiflu (oseltamivir), which may have skewed the results and makes it hard to draw any conclusions from the findings, said Dr. Tom Jefferson of the Center for Evidence Based Medicine at the University of Oxford in the U.K., who was not part of the study.
...Jefferson told… The study was also very small and took three years to go from completion to publication, which is strange, he said.…
If the same trial were conducted today, it is unlikely she and her coauthors would have given the participants Tamiflu, she said.
“Probably the best way to alleviate flu symptoms is to get vaccinated against the flu,” Braithwaite said. “This is highly recommended for those who are very young, very old, pregnant or who suffer from respiratory or other chronic illnesses.”
повышению риска
А жаропонижающие свойства парацетамола не подвергаются никакому сомнению
Мы обнаружили, что нет никакой разницы в… температуре
Регулярный прием парацетамола не позволяет снизить температуру
A 2013 Cochrane systematic review of placebo-controlled trials using vitamin C doses of at least 200 mg/day found that routine vitamin C supplementation did not prevent colds in the general population, but halved the common cold risk in people exposed to short periods of extreme physical stress, shortened colds by 8 percent in adults and up to 18 percent in children, and reduced severity of symptoms. Only seven clinical trials tested vitamin C as a treatment after the onset of cold symptoms, and three of those trials showed a benefit, but considering the benefits of routine vitamin C supplementation, the review concludes, «it may be worthwhile for common cold patients to test on an individual basis whether therapeutic vitamin C is beneficial for them.»
The North American Dietary Reference Intake recommends 90 milligrams per day and no more than 2 grams (2,000 milligrams) per dayВ других странах = от 40 до 100 в среднем.
Tolerable Upper Intake Level (adult male) == 2,000 mg per dayВ России аналогично.
BACKGROUND:
Acetaminophen is frequently prescribed for treating patients with the common cold, but there is little evidence as to whether it is effective.
OBJECTIVES:
To determine the efficacy and safety of acetaminophen in the treatment of the common cold in adults.
…
MAIN RESULTS:… Acetaminophen did not improve sore throat or malaise in two of the four studies. Results were inconsistent for some symptoms… None of the included studies reported the duration of common cold symptoms.…
AUTHORS' CONCLUSIONS:… The data in this review do not provide sufficient evidence to inform practice regarding the use of acetaminophen for the common cold in adults. Further large-scale, well-designed trials are needed to determine whether this intervention is beneficial in the treatment of adults with the common cold.
This trial investigates the effects of paracetamol on viral shedding and clinical symptoms in adults with community-acquired influenza infection. We hypothesized that regular administration of paracetamol during confirmed influenza infection is associated with prolonged viral shedding, worse symptoms, and prolonged illness duration.
Inclusion criteria:То есть они осознанно взяли всех, у кого острый период уже прошел, исключив тех, на ком и надо было экспериментировать — на лихорадящих с жаром за 38. Вывод: исследование реально полнейший бред.
• Age 18 to 65 years
• Onset of an influenza like illness in the past 48 hours: history of fever or documented temperature ≥ 37.8°, and at least one of cough, sore throat, rhinorrhea, headache, myalgia, fatigue, or malaise
Exclusion criteria:
• Influenza illness severe enough to warrant hospital admission
one participant withdrew after 4 days due to a serious adverse event (acute kidney injury)У одного почки таки не выдержали издевательства.
Последняя рекомендация имеет лишь то основание, что это может помочь и вряд ли может причинить вред
Лечение гриппа: помогает ли парацетамол?