Saturday, July 26, 2008

Naproxen Test



The patients were given Naproxen Sodium at 500 mg/tablet, one tablet every 12 hours p.c. for a total of 4 doses. Body temperature was taken orally every two hours prior.

Naproxen 500 mg/tablet Every 12 Hours P.C For 2 Days


Fever lysis after or within the time frame of drug administration was interpreted as suggestive of either a neoplastic condition or a connective tissue disease.
Nonresponse of the fever to the drug was taken to suggest an infectious condition.

Naproxen Administration was discontinued if any of the following were noted :

1). Hypersensitivity reaction,
2). Abdominal complaints, or
3). Patient refusal to take the drug.


Postulated pathogenic mechanisms for its occurrence include massive tumor necrosis, extensive neoplastic cell destruction, local inflammation due to ulceration of normal or malignant tissue, leucocytic infiltration of the neoplasm, interference with conjugation of pyrogenic steroids secondary to liver metastases and excessive heat production by tumor cells.

Neoplastic Fever is the second most common cause of fever in cancer patients after infection. The establishment of the etiology of fever in patients with malignancy however, remains to be a challenging diagnostic scenario for clinicians. Distinguishing between infectious fever and neoplastic fever is of paramount importance in cancer patients because of the urgency and necessity for appropriate treatment in these immunocompromised hosts.

The more recent mechanism involves induction of pyrogenic cytokines such as tumor necrosis factor, interleukins 1 and 6 and interferon by the tumor cells itself or by host macrophages in response to the tumor. Cytokines stimulate production of prostaglandin E2 which act on the hypothalamus causing a change in the thermostatic set point. Naproxen is a non-steroidal anti-inflammatory drug which acts as an inhibitor of cyclooxygenase. It has been demonstrated to have both analgesic and antipyretic effects.

Subsequent observational studies on small groups of patients with specific malignancies similarly
had promising results, but likewise suffered from this critical flaw. This precluded further estimation of the sensitivity, specificity and likelihood ratios of the naproxen test. It is suggested that the more appropriate reference standard would be the absence of infection after extensive and thorough laboratory work-up coupled with the absence of any clinical deterioration without administration of any antibiotics on continued follow-up for at least a period of 2 weeks. Specifically, the more convincing evidence that a patient does not have any infection despite extensive work-up would be the non-deterioration of the patient in the absence of any antibiotics during a prolonged follow-up period.

With the advent of modern diagnostic technology, it is timely that the usefulness of this
test be re-evaluated in the present decade. In the Philippines, it is best that this test be validated in a tertiary center with a laboratory and radiology department that is equipped with highly sensitive diagnostic and imaging procedures that are needed to rule out any infection from bacterial, viral, fungal or parasitic etiology. Likewise the staff should be competent in the performance and interpretation of these procedures.

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