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Am Fam Physician. 2004;69(11):2690

The usefulness of syrup of ipecac as a home treatment for poisoning has been increasingly challenged, and many poison centers no longer recommend its use. Bond studied data from poison centers to determine whether syrup of ipecac reduces referrals to the emergency department or improves outcomes after accidental ingestion of pharmaceuticals.

Bond used data from 2000 and 2001 from the American Association of Poison Control Centers' Toxic Exposure Surveillance System to determine the correlation between rates of home use of syrup of ipecac and recommendations for emergency department referral. Adverse outcome data also were collected. The 64 poison centers that met eligibility requirements reported that of the 754,602 calls that met eligibility criteria, 669,869 children intentionally were treated at home, 60,681 children were referred to an emergency department by poison center staff, 7,294 children refused referral and were treated at home, 14,404 children were self-referred, and 2,354 were not classified as to referral status. The mean rate of referral by the poison centers was 9 percent. Increased home use of syrup of ipecac was not associated with referral to an emergency department. Groups with higher and lower home use of syrup of ipecac did not differ by referral rate or outcome.

Bond concludes that selective home administration of syrup of ipecac will not improve outcome or reduce use of emergency department services. Lack of correlation between use of syrup of ipecac and referral reduction does not mean that syrup of ipecac is ineffective. However, the benefit is likely to be small and may vary too much for public health implications. The author concludes that if syrup of ipecac does not play a significant role in reducing emergency department visits, it is unlikely to play a significant role in injury prevention.

editor's note: Because of the declining rate in poisoning in previous decades, the lack of a demonstrated benefit of syrup of ipecac in spite of the theoretic benefits, and the findings of this study, the American Academy of Pediatrics (AAP) no longer recommends keeping syrup of ipecac in the home. An additional consideration is that syrup of ipecac has abuse potential among bulimic patients and patients with Munchausen or Munchausen by proxy syndrome. The AAP now recommends that physicians provide parents with the poison control center's telephone number (800-222-1222).—C.W.

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