Antipyretic Efficacy of Acetaminophen and Ibuprofen in Critically Ill Pediatric Patients

Abstract

Objectives: To determine the antipyretic efficacy of acetaminophen (IV, enteral, rectal) and ibuprofen (enteral) in critically ill febrile pediatric patients. Design: Retrospective cohort study. Setting: Quaternary care pediatric hospital ICUs. Patients: Pediatric patients less than 19 years old who were febrile (≥ 38.0°C), received a dose of IV acetaminophen, enteral acetaminophen, rectal acetaminophen, or enteral ibuprofen and had at least one temperature measurement in the following 6 hours. Interventions: None. Measurements and Main Results: A total of 3,341 patients (55.8% male, median age 2.5 yr [interquartile range, 0.63–9.2 yr]) met study criteria. Baseline temperature was median 38.6°C (interquartile range, 38.3–38.9°C) measured via axillary (76.9%) route. Patients became afebrile (87.5%) at median 1.4 hours (interquartile range, 0.77–2.3 hr) after the first dose of medication, a –2.9 ± 1.6% change in temperature. Antipyretic medications included as follows: enteral acetaminophen (n = 1,664), IV acetaminophen (n = 682), rectal acetaminophen (n = 637), and enteral ibuprofen (n = 358). Enteral ibuprofen had a significantly greater odds of defervescence on multivariable logistic regression analysis (p = 0.04) with a decrease of –1.97 ± 0.89°C while IV acetaminophen was significant for a decreased time to defervescence at median 1.5 hours (interquartile range 0.8–2.3 hr) after a dose (p = 0.03). Patient age, presence of obesity, and baseline temperature were significant for decreased antipyretic efficacy (p < 0.05). Conclusions: Enteral ibuprofen was the most efficacious antipyretic and IV acetaminophen had the shortest time to defervescence.

Ibuprofen efficacy, tolerability and safety in obese children: a systematic review

“…The four included studies involved 1141 children and young people. Five hundred eighty-three participants (median age: 6 years, range: 1–18 years) were included in the first cohort study,14 11 out of 200 children had taken ibuprofen (median age for ibuprofen participants: not specified, median age of total population: 11 years, range: 11–18 years) in the second cohort study15 and 358 participants (median age: 3.1, range: 1.2–8.5 years) in the third cohort study 16. The fourth study was a case study evaluating prescriptions of critically ill infants and children (age <18 years) but did not state the number of participants in their sample size or their age distribution 17.…”

“…The fourth study was a case study evaluating prescriptions of critically ill infants and children (age <18 years) but did not state the number of participants in their sample size or their age distribution 17. There was a relatively even distribution of males and females in the three retrospective cohorts,14 15 but the case study did not state the gender distribution in their sample 16…”

“…Three papers shared the Centres for Disease Control and Prevention’s definition of obesity: obesity as a body mass index (BMI) above the 95th percentile,14 16 17 whereas one paper defined obesity based on a BMI z-score 15. Two cohort studies clearly differentiated the numbers of obese and non-obese children in their sample with the first having 189 obese and 394 non-obese participants 14.…”

“…Two cohort studies clearly differentiated the numbers of obese and non-obese children in their sample with the first having 189 obese and 394 non-obese participants 14. The second cohort study had a total of 366 obese and 2975 non-obese participants, of which 38 obese (10.6%) and 320 non-obese individuals (89.4%) were on ibuprofen 16. Another cohort study had a mean BMI z-score of 2.95 (n=200, range: 1.28–9.72) of its total sample, but did not clearly distinguish the numbers of obese and non-obese children 15.…”

“…The use of ibuprofen differed among the four papers: one retrospective cohort study investigated the pain relief from ibuprofen post-tonsillectomy,14 the second retrospective cohort study investigated the currently applied dosage strategies in overweight or obese children by looking at their prescriptions,15 the third retrospective cohort study assessed the antipyretic efficacy in critically ill paediatric patients16 and the case study investigated prescriptions for commonly prescribed drugs to aid in the development of a decision support tool 17…”