Warning On Chicken Pox, Ibuprofen -- Painkiller May Be Linked To Flesh-Destroying Germs

King County health officials are warning physicians not to prescribe certain aspirin substitutes for chicken pox because of their possible link with the serious, flesh-destroying infections that hospitalized 12 children in Seattle in the past year.

All of the children had chicken pox, and at least six took ibuprofen while they had the infections or related serious complications.

The health warning extends to all aspirin substitutes called non-steroidal anti-inflammatory drugs. It does not include acetaminophen products, such as Tylenol, which is not an anti-inflammatory.

"We're not really sure there is a connection yet. We need to look at it in further detail. But, meanwhile, we don't think they should use (the drugs)," said Dr. Russell Alexander, director of communicable-disease control for the Seattle-King County Health Department.

Dr. Craig Rubens, a Children's Hospital & Medical Center physician who is conducting research on the infections, said the drug doesn't cause the infection but may make it worse.

"It may mask (symptoms) or may have an effect on immunity for this condition," Rubens said.

Alexander found the medical records of six children showed they had been given ibuprofen, probably to treat the fever and pain associated with the infection. Health officials are checking with the parents of the other children to see whether they received ibuprofen, which includes such over-the-counter brands as Advil and

Motrin.

Dr. Marc Deitch, vice president and medical director of Wyeth-Ayerst Laboratories, maker of liquid Children's Advil Suspension, said there are often anecdotal associations with medications when rare, serious medical problems occur.

He said the company had tested its product on 30,000 children with fevers over two years and that none contracted the flesh-destroying infection. He said he now will check to see whether any had chicken pox.

"We'll follow up with Dr. Rubens and try to be of any help we can," Deitch said.

A spokesman for McNeil Consumer Products Co., maker of Children's Motrin Suspension, or PediaProfen, said the company had no comment.

The infections, called necrotizing fasciitis, occurred when a particularly virulent strain of the bacteria Group A streptococcus - or, less frequently, staphylococcus bacteria - entered one of the deep chicken-pox sores and secreted a powerful toxin.

Flesh had to be surgically removed from all of the children to stop the infections. One 6-month-old had surgery on her face and neck and was on a respirator for several days. All of the children have recovered.

Alexander and Rubens said three studies have been reported in medical journals of adults who contracted the infections and used non-steroidal anti-inflammatory drugs. The drugs, which normally aren't given to children, included indomethacin, diclofenac and phenylbutazone.

Rubens and his colleagues are submitting an analysis of four of the recent children's cases to a pediatrics journal. They recommend against use of the anti-inflammatory aspirin substitutes for bacterial infections stemming from chicken pox.

Physicians have long recommended against giving children aspirin for chicken pox or influenza. Use of aspirin with those diseases has been linked to Reye's syndrome, a rare, potentially fatal illness.

As for ibuprofen, Rubens said laboratory research has suggested that the medication may impair the function of disease-fighting white cells. Or, he said, it could mask fever and pain associated with the infections. As a result, the seriousness of the problem might not be realized, and without aggressive treatment, the infection could accelerate.

Rubens said people should not stop taking the medications for other reasons besides the infections. They should consult their physicians if they have any doubts.

Alexander will issue the warning in the upcoming issue of Epi-Log, the Health Department's monthly newsletter to health-care providers.

He said aggressive treatment of the necrotizing fasciitis cases at Children's Hospital probably saved some lives. In the Los Angeles area during 1993 and 1994, there were five deaths among 28 patients with the infections following chicken pox.

Alexander said the chicken-pox season runs through May and that there likely will be further cases of the infections. He urged vigilance for the symptoms:

-- Inflammation that has spread beyond the area of the chicken-pox sores. The sores should be no larger than a quarter.

-- Pain around the inflammation.

-- Fever that returns three or four days after the start of chicken pox and accompanies the inflammation.

He said children should be prevented from scratching the itchy, healing sores.