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									                                                                   11 December 2002

                                                                     Pain Relief Unit
                                                                   Churchill Hospital
                                                                     Oxford OX3 7LJ
                                                                   4 November 2002.

Dr H V.Hogerzeil
Expert Committee on Selection
and Use of Essential Medicines
CH -1211 Geneva.

Dear Dr Hogerzeil

Re Application for inclusion of paediatric ibuprofen on WHO Essential Medicines

Thank you for your letter of September 18th relating to a request for paediatric
ibuprofen to be added to the Model List. The application from Boots Healthcare
International makes reference to a variety of evidence but the majority is not cited. I
was unable to identify any convincing evidence for the effectiveness of ibuprofen in
treating fever although ibuprofen (and other NSAIDs) are used for that purpose. The
only two references cited by Boots refer to safety. Randomised controlled trials
comparing paracetamol and ibuprofen exist and generally show that ibuprofen is as
effective as paracetamol. Paracetamol is available on the Model List in a paediatric
formulation and I would recommend that in the absence of convincing evidence,
ibuprofen should not be added to the Model List.

It should be pointed out that ibuprofen is recommended for pain and fever in
children in the WHO Model Formulary.
Boots point out that acetylsalicylic acid should not be administered to children, this
also is mentioned in the Model Formulary but perhaps should be made explicit in
the Model List

Yours Sincerely

Philip J Wiffen
Co-Ordinating Editor
Cochrane Pain & Palliative Care Group

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