eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Rubella: Treatment & Medication

Author: Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Coauthor(s): Peter Bloomfield, MD, MPH, Clinical Instructor, Olive View-UCLA Department of Emergency Medicine; Director, Quality Assurance, Brotman Medical Center Emergency Medicine
Contributor Information and Disclosures

Updated: Sep 25, 2009

Treatment

Emergency Department Care

No antiviral therapy for rubella is available. Treatment is supportive.

Medication

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Antipyretics

These agents may be used to decrease fever. 


Acetaminophen (Tylenol)

Reduces fever by direct action on the hypothalamic heat-regulating centers, which increases dissipation of body heat by vasodilation and sweating.

Adult

1000 mg PO tid/qid; not to exceed 4 g/d

Pediatric

<12 years: 10-15 mg/kg/dose PO q4-6h prn; not to exceed 2.6 g/d
>12 years: 325-650 mg PO q4h prn; not to exceed 5 doses/d

Rifampin can reduce analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity

Documented hypersensitivity; G-6-PD deficiency

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Hepatotoxicity possible in persons with chronic alcoholism at various dose levels; severe or recurrent pain or high or continued fever may indicate serious illness; contained in many OTC products, and combined use may result in cumulative doses exceeding recommended maximum dose


Ibuprofen (Motrin, Advil)

NSAID that inhibits cyclooxygenase, inhibiting formation of prostaglandins.

Adult

200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d

Pediatric

6 months to 12 years: 5 mg/kg/dose PO q6-8h prn for temperature <102.5°F; 10 mg/kg/dose PO q6-8h prn for temperature >102.5°F; not to exceed 40 mg/kg/d
>12 years: Administer as in adults

Coadministration with aspirin increases risk of serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy

Antihistamines

May be used to control itching.


Diphenhydramine (Benadryl)

Competitive antagonist of histamine at the H1 receptor prevents histamine response in sensory nerve endings and blood vessels. More effective in preventing histamine response than reversing it.

Adult

25-50 mg PO q6-8h prn; 10-50 mg IV/IM q6-8h prn; not to exceed 400 mg/d

Pediatric

5 mg/kg/d PO or 150 mg/m2/d PO divided tid/qid; 5 mg/kg/d IV/IM or 150 mg/m2/d IV/IM divided qid; not to exceed 300 mg/d

Potentiates effect of CNS depressants; due to alcohol content, do not administer syrup form to patient taking medications that can cause disulfiramlike reactions

Documented hypersensitivity; MAOIs

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

May exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction; may cause paradoxical excitation in pediatric patients

More on Pediatrics, Rubella

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Differential Diagnoses & Workup: Pediatrics, Rubella
Treatment & Medication: Pediatrics, Rubella
Follow-up: Pediatrics, Rubella
Multimedia: Pediatrics, Rubella
References
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References

  1. Watstein SB, Jovanovic J. Statistical Handbook on Infectious Diseases. Westport, CT: Greenwood; 2003:5.

  2. CDC. Elimination of rubella and congenital rubella syndrome--United States, 1969-2004. MMWR Morb Mortal Wkly Rep. Mar 25 2005;54(11):279-82. [Medline].

  3. Elliman D, Bedford H. MMR: where are we now?. Arch Dis Child. Dec 2007;92(12):1055-7. [Medline].

  4. Schmid D, Kasper S, Kuo HW, Aberle S, Holzmann H, Daghofer E. Ongoing rubella outbreak in Austria, 2008-2009. Euro Surveill. 2009;14(16):[Medline].

  5. Ahlgren C, Toren K, Oden A, Andersen O. A population-based case-control study on viral infections and vaccinations and subsequent multiple sclerosis risk. Eur J Epidemiol. Jul 26 2009;[Medline].

  6. McElroy R, Laskin M, Jiang D, Shah R, Ray JG. Rates of rubella immunity among immigrant and non-immigrant pregnant women. J Obstet Gynaecol Can. May 2009;31(5):409-13. [Medline].

  7. CDC. CDC. Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report. Achievements in Public Health: Elimination of Rubella and Congenital Rubella Syndrome—United States, 1969-2004. JAMA. 2005;293:2084-6.

  8. Fisher RG, Boyce TG. Prenatal infections. In: Moffet's Pediatric Infectious Disease: A Problem-Oriented Approach. Lippincott Williams & Wilkins; 2005:631-2.

  9. Maldonado Y. Rubella. In: Behrman RE, Kliegman R, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: WB Saunders; 2004:1032-4.

  10. Mercurio MG, Elewski BE. Cutaneous manifestations of systemic viral, bacterial, and fungal infections and protozoal disease. In: Dermatologic Signs of Internal Disease. 2nd ed. 1995:254.

  11. Palacin PS, Castilla Y, Garzon P, Figueras C, Castellvi J, Espanol T. Congenital rubella syndrome, hyper-IgM syndrome and autoimmunity in an 18-year-old girl. J Paediatr Child Health. Oct 2007;43(10):716-8. [Medline].

  12. Sanchez PJ. Viral infections of the fetus and neonate. In: Feigin RD, Cherry J, Demmler GJ, Sheldon S, eds. Textbook of Pediatric Infectious Diseases. Philadelphia, PA: Saunders; 2004:881-5.

  13. Smith A, Yarwood J, Salisbury DM. Tracking mothers' attitudes to MMR immunisation 1996-2006. Vaccine. May 16 2007;25(20):3996-4002. [Medline].

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Further Reading

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Keywords

rubella, rubella virus, German measles, congenital rubella syndrome, three-day measles, 3-day measles, MMR vaccine, childhood immunization

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Contributor Information and Disclosures

Author

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Peter Bloomfield, MD, MPH, Clinical Instructor, Olive View-UCLA Department of Emergency Medicine; Director, Quality Assurance, Brotman Medical Center Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Garry Wilkes, MBBS, FACEM, Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Director, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia, Australia.
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Grace M Young, MD, Associate Professor, Department of Pediatrics, University of Maryland Medical Center
Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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