Ibuprofen vs Acetaminophen for the Treatment of Fever or Pain in Children Younger than 2 Yrs

17 Apr, 23

Introduction

Fever and pain management in children includes acetaminophen (paracetamol) and ibuprofen, the most widely prescribed and available over-the counter medications. Limited data exist on the efficacy and safety of ibuprofen in younger children

Aim

This systematic review compared antipyretic, analgesic, and safety profiles of acetaminophen with ibuprofen for the short-term treatment of fever or pain in children younger than 2 years.

Patient Profile

Children younger than 2 years

Methods

Systematic review
19 studies consisting of 241138 participants from 7 countries and various health care settings (hospital-based and community-based comparing short-term use of acetaminophen with ibuprofen for fever or pain in children younger than 2 years were included

Study Outcomes

The primary outcomes were fever or pain within 4 hours of treatment onset.
Safety outcomes included serious adverse events, kidney impairment, gastrointestinal bleeding, hepatotoxicity, severe soft tissue infection, empyema, and asthma and/or wheeze.

Results

Ibuprofen was associated with reduced temperature within 4 hours (P = .01) compared with acetaminophen

Table 1: Antipyretic profile of ibuprofen vs acetaminophen from randomized Studies

Source	Outcome	Acetaminophen	Total	Ibuprofen	Total
Temperature or change in temperature at <4 h
Aksoylar et al 1997	Temperature, 3 h	38.40	51	37.90	50
Autret et al, 1997	Mean reduction in temperature, 1 h	0.90		–0.97	114
Erlewyn-Lajeunesse et al, 2006	Mean temperature, 1h	37.95	25	37.76	22
Van Esch et al, 1995	Mean temperature, 2 h	37.96	29	37.60	30
Subtotal			219		216
Temperature or change in temperature at 4-24 h
Autret et al, 1994	Mean reduction in temperature, 0-4 h	–1.02	74	–1.32	77
Autret et al, 1997	Mean reduction in temperature, 4 h	–1.04	110	–1.42	112
McIntyre and Hull, 1996	Mean change from baseline temperature, 4 h	–1.60	66	–1.80	69
Sarrell et al, 2006	Fever, 1 d	40.55	154	40.6	155
Van Esch et al, 1995	Mean temperature, 4 h	37.95	31	37.38	31
Subtotal			435		444
Hay et al, 2008	Temperature, 48 h	36.4	51	36.4	47
Sarrell et al, 2006	Fever, 2 d	39.74	154	39.66	155
Subtotal			205		202
Temperature or change in temperature at >3 d
Hay et al, 2008	Temperature, 5 d	36.2	48	36.1	45
Subtotal			48		45

Compared with acetaminophen, ibuprofen was associated with less pain at 4 to 24 hours from treatment onset
Adverse events were uncommon
Acetaminophen and ibuprofen appeared to have similar serious adverse event profiles (odds ratio, 1.08; P = .50, I2 = 0%; moderate-quality evidence)

Conclusion

Use of ibuprofen vs acetaminophen for the treatment of fever or pain in children younger than 2 years was associated with reduced temperature and less pain within the first 24 hours of treatment.

The 2 medications appear to have equivalent safety in the short term, with very low rates of adverse events overall.

Reference

JAMA Network Open. 2020;3(10):e2022398.