Effectiveness of paracetamol versus ibuprofen administration in febrile children: A systematic literature review

Narayan, Kaajal; Cooper, Simon; Morphet, Julia; Innes, Kelli

doi:10.1111/jpc.13507

Cited by 19 publications

(9 citation statements)

References 29 publications

(51 reference statements)

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“…Ibuprofen and paracetamol are the only antipyretics recommended in febrile children, basing on abundant evidence of their efficacy and safety profile. A recent systematic literature review (7), including eight studies on 1,632 children, concluded that both drugs are equally effective in reducing fever and discomfort in children. Other literature reports, including two meta-analyses (8, 9), observed a similar safety profile (10).…”

Section: Introductionmentioning

confidence: 99%

Prescribing Controversies: An Updated Review and Meta-Analysis on Combined/Alternating Use of Ibuprofen and Paracetamol in Febrile Children

et al. 2019

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Background: Ibuprofen and paracetamol are the only antipyretics recommended in febrile children. According to international guidelines the choice of the drug should rely on the child's individual characteristics, while a controversial issue regards the combined or alternate use of the two drugs. Objective: To compare the efficacy and safety of combined or alternating use of ibuprofen and paracetamol in children. Methods: A systematic review of literature was performed on Medline and Embase databases. The included studies were randomized controlled trials analyzing the efficacy of combined or alternating therapy with antipyretics in febrile children vs. monotherapy. A meta-analysis was performed to measure the effect of treatment on child's temperature and discomfort. Adverse effects were analyzed as secondary outcome. Results: Nine studies were included, involving 2,026 children. Mean temperature was lower in the combined therapy group at 1 h (mean difference: −0.29°C; 95%CI: −0.45 to −0.13) after the initial administration of therapy. No statistical difference was found in mean temperature at 4 and 6 h from baseline. A significant difference was found in the proportion of children reaching apyrexia at 4 and 6 h with the combined treatment (RR: 0.18, 95%CI: 0.06 to 0.53, and 0.10, 95%CI: 0.01–0.71, respectively) and at 6 h with alternating treatment (RR: 0.30, 95% CI: 0.15–0.57), compared to children treated with monotherapy. The child's discomfort score was slightly lower with alternating therapy vs. monotherapy. The pooled mean difference in the number of medication doses per child used during the first 24 h was not significantly different among groups. Discussion: Combined or alternating therapy resulted more effective than monotherapy in reducing body temperature. However, the benefit appeared modest and probably not clinically relevant. The effect on child discomfort and number of doses of medication was modest as well. According to our findings, evidences are not robust enough to encourage combined or alternating paracetamol and ibuprofen instead of monotherapy to treat febrile children, reinforcing the current recommendation of most of the international guidelines.

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Section: Introductionmentioning

confidence: 99%

Prescribing Controversies: An Updated Review and Meta-Analysis on Combined/Alternating Use of Ibuprofen and Paracetamol in Febrile Children

et al. 2019

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“…Level 3; relieves discomfort in febrile illness (down-graded because SR only included 3 studies and only 44% of children showed less discomfort compared to ibuprofen 69%); (SR)[88] Sole recommended antipyretic 9No published evidence comparing ibuprofen and paracetamol shows a superior effect or safety profile of paracetamol (Review appraisal)[90] As the 1st line antipyretic 17 Level 1; review appraisal[90] SR[89] As 2nd line antipyretic after ibuprofen/physical methods 1 Level 2; RCT, meta-analysis[91] Dose determination Follow doctor's advice 6 Level 1; dose by weight and/or age; SR[89] https://doi.org/10.1371/journal.pone.0245815.t001…”

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confidence: 99%

Symptomatic fever management in children: A systematic review of national and international guidelines

et al. 2021

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Introduction Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out. Methods Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country (with date coverage from January 1995 to September 2020). Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis. Methods and results are reported according to the PRISMA statement. Results 74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3–4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis. Conclusion There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence–this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.

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“…reviewed 3023 articles related to oral paracetamol and ibuprofen in pediatric fever management, and in 6 out of 8 studies meeting the criteria, ibuprofen proved somewhat, though not significantly, more effective than paracetamol in reducing fever in children. [ 21 ] When it comes to our study, fever decline between baseline and 60 min remained unchanged in both groups, and we concluded that ibuprofen and paracetamol could be antipyretic equals. From this perspective, the results obtained in our study seem to validate the data reported in Narayan et al .…”

Section: Discussionmentioning

confidence: 48%

Comparative evaluation of the efficacy of intravenous paracetamol and ibuprofen on the treatment of tonsillopharyngitis with fever: A prospective, randomized controlled, double-blind clinical trial

et al. 2021

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Effectiveness of paracetamol versus ibuprofen administration in febrile children: A systematic literature review

Abstract: There is little evidence supporting the superior efficacy of paracetamol or ibuprofen in the treatment of fever in children with indications that both drugs are equally effective.

Cited by 19 publications

References 29 publications

Prescribing Controversies: An Updated Review and Meta-Analysis on Combined/Alternating Use of Ibuprofen and Paracetamol in Febrile Children

Prescribing Controversies: An Updated Review and Meta-Analysis on Combined/Alternating Use of Ibuprofen and Paracetamol in Febrile Children

Symptomatic fever management in children: A systematic review of national and international guidelines

Comparative evaluation of the efficacy of intravenous paracetamol and ibuprofen on the treatment of tonsillopharyngitis with fever: A prospective, randomized controlled, double-blind clinical trial

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