Prevalence and outcome of children with acute viral hepatitis using complementary and alternative medications (CAM) presenting to a tertiary care center of North India: A prospective observational study

Objective The use of complementary and alternative medicine (CAM) is a widespread practice worldwide for treating a variety of health conditions. The impact of CAM related drug induced liver injury (DILI) in pediatric population is not known. Therefore, this study is planned to examine the prevalence of use of CAMs in children with acute viral hepatitis (AVH) and to describe the outcome of CAM related liver injury (second hit) in children with hepatitis A and E related AVH. Methods This prospective observational study included children aged 1 to 18 years with AVH who presented to a tertiary care center in North India between April 2024 and September 2024. Clinical and laboratory details were noted on a predesigned format, including detailed history of use of CAM. Groups of children with AVH with and without use of CAMs were compared. Result During the study period 78 patients with AVH presented to the Department of Paediatrics of which 60 were enrolled. Thirty-seven (62%) had history of CAM use in past. On univariate analysis, pruritus (p = 0.021), ascites (p < 0.001), hepatic encephalopathy (p = 0.021), and pediatric acute liver failure (PALF) (p = 0.001) were significantly more common among children with acute viral hepatitis who used complementary and alternative medicine (CAM). Variables found to be significant on univariate analysis were subjected to multivariate analysis. PALF (adjusted OR: 9.141; 95% CI: 1.526–54.764; p = 0.015) was independently associated with CAM use among children with AVH. The mortality rate among children with AVH who used CAM was 5.4% in this study. Conclusion The present study clearly highlights the high prevalence of CAM use in the pediatric population with AVH. Pruritus , ascites and PALF complicate, natural AVH course with CAM use.