Effects of acetaminophen and ibuprofen monotherapy in febrile children: a meta-analysis of randomized controlled trials

Abstract

Introduction When a child presents with fever in the clinical encounter, parents are usually concerned about alleviating the fever. However, the indications for selecting an appropriate drug from the most commonly used antipyretic drugs acetaminophen and ibuprofen remain unclear. The purpose of this study was to assess the efficacy and safety of acetaminophen and ibuprofen in febrile children through a systematic review with meta-analysis of randomized controlled trials (RCTs). Material and methods Cochrane, Embase, and PubMed databases were searched for the relevant RCTs. Two authors individually extracted information on trial design, demography, rate of fever resolution, body temperature, and overall adverse event. Data were pooled mainly using random-effects model; however, because of some sparse data, Peto odds ratios (PORs) were used for outcomes of fever resolution and adverse event. 95% confidence intervals (CIs) were also presented. Results In total, 26 RCTs (n=4137) fulfilled eligibility criteria. Pooled estimates demonstrated that acetaminophen led to significantly lower fever resolution rates than ibuprofen did (POR=0.91, 95%CI: 0.84–0.98; I2=0%) in the subgroup of trials with a mean age of <2 years. However, the treatment–time interaction model for body temperature demonstrated that the fever resolution effect was mainly from the time factor based on the available data (effect size=−0.20; 95%CI: −0.30 to −0.11; I2=6.9%). Acetaminophen demonstrated a lower overall adverse event rates than ibuprofen (POR=0.71; 95%CI: 0.58–0.87; I2=0%). Conclusions The effects of ibuprofen are similar to acetaminophen even in children mean aged approximately 5 years old. Nevertheless, acetaminophen is safer than ibuprofen, particularly in children approximately 5 years old.

Keywords

• fever resolution
• fever
• pediatric
• paracetamol
• ibuprofen