Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years

Tan, Eunicia; Braithwaite, Irene; McKinlay, Christopher J. D.; Dalziel, Stuart R

doi:10.1001/jamanetworkopen.2020.22398

Cited by 71 publications

(56 citation statements)

References 56 publications

(280 reference statements)

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“…and focused on children under 2 years old [11]. Moreover, six related RCTs on this topic had been published before the previous systematic reviews [12][13][14][15][16][17].…”

Section: P R E P R I N Tmentioning

confidence: 99%

Effects of Acetaminophen or Ibuprofen Monotherapy in Febrile Children: A Meta-Analysis of Randomized Controlled Trials

Kuo

Hou

et al. 2021

Arch Med Sci

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IntroductionWhen 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 methodsCochrane, 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.ResultsIn 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%).ConclusionsThe 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.

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“…and focused on children under 2 years old [11]. Moreover, six related RCTs on this topic had been published before the previous systematic reviews [12][13][14][15][16][17].…”

Section: P R E P R I N Tmentioning

confidence: 99%

Effects of Acetaminophen or Ibuprofen Monotherapy in Febrile Children: A Meta-Analysis of Randomized Controlled Trials

Kuo

Hou

et al. 2021

Arch Med Sci

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“…None of the included reviews, barring Cheelo et al, 16 conducted a sensitivity analysis for this. Systematic reviews of RCTs comparing the asthma incidence in children with postnatal exposure to paracetamol or ibuprofen have not found any difference between the two, again supporting confounding by indication 60,61 . One RCT comparing prenatal paracetamol and ibuprofen exposure, enrolling children above 2 months of age, with a 6‐year follow‐up is currently underway 62 …”

Section: Discussionmentioning

confidence: 99%

Paracetamol exposure and asthma: What does the evidence say? An overview of systematic reviews

Singh

Varukolu²,

Chauhan

et al. 2021

Pediatric Pulmonology

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Objective To conduct an umbrella review collating the existing evidence to determine whether there is an association between exposure of Paracetamol in‐utero or in infancy and the development of childhood Asthma. Methods In this review, systematic reviews with or without meta‐analysis that reported the association between paracetamol and asthma in children were included. To identify relevant reviews, a search was performed in the electronic databases PubMed, the Cochrane Library, and Ovid MEDLINE. The protocol was registered in PROSPERO CRD42020156023. A separate search was conducted for primary studies from the last 5 years not yet included in systematic reviews reporting the association from January 2016 to March 2021. Results The electronic searches identified 1966 review titles. After the removal of 493 duplicates, 1475 titles and abstracts were screened against the eligibility criteria. Full‐text screening yielded six systematic reviews to be included in this review. The search for primary studies in the last 5 years yielded 1214 hits, out of which 5 studies were found suitable for inclusion. Three of them, that were not included in the systematic reviews, and have been summarised in this paper. The odds ratios (ORs) for the outcome of asthma in offspring of mothers with prenatal paracetamol consumption in any trimester were 1.28 (1.13–1.39) and 1.21 (1.02–1.44). For first trimester exposures, they were 1.12 (0.99–1.27), 1.39 (1.01–1.91), and 1.21 (1.14–1.28), for the second or third trimester, they were 1.49 (1.37–1.63) and 1.13 (1.04–1.23). For the third trimester only, the figure was 1.17 (1.04–1.31). Of the six reviews included, 1 had a low risk of bias, 2 had an unclear risk while 3 had a high risk of bias assessed using the ROBIS tool. There was no significant increased risk of asthma with early infancy exposure. The inter‐study heterogeneity varied from I2 = 41% to I2 = 76% across reviews. In the primary studies, the OR for prenatal exposure ranged from 1.12 (0.25–4.98) to 4.66 (1.92–11.3) and for infancy exposure was 1.56 (1.06–2.30). All three included primary studies were adjudged to be of high quality using the Newcastle Ottawa scale. Conclusions There is a modest association between paracetamol exposure in‐utero and the future development of asthma. Exposure in infancy has a less consistant association. All the studies done thus far are observational in nature, with their inherent biases. Further research, preferably randomized controlled trials are recommended to answer this pertinent question.

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“…This is consistent with the findings previously reported by various authors. Southey et al, 2009, and Tan et al, 2020, showed that ibuprofen and acetaminophen have similar safety profiles in pediatric patients [ 47 , 48 ]. van Walsem et al, 2015, found that the risk of fatal and nonfatal severe events was similar between diclofenac, acetaminophen, naproxen, ibuprofen, celecoxib, and etoricoxib.…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis of the Analgesic Efficacy of Single-Doses of Ibuprofen Compared to Traditional Non-Opioid Analgesics Following Third Molar Surgery

et al. 2021

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The purpose of this systematic review was to determine the analgesic efficacy and adverse effects of ibuprofen in comparison with other traditional non-opioid analgesics after third molar surgery. A total of 17 full texts were identified in PubMed and assessed using the Cochrane Collaboration’s risk of bias tool by two independent researchers. The sum of pain intensity differences, total pain relief, the overall evaluation, the number of patients requiring rescue analgesics, and adverse effects were collected. Data were analyzed using the Review Manager Software 5.3. for Windows. A total of 15 articles met the criteria. The qualitative and quantitative analysis showed that ibuprofen is more effective to relieve post-operative dental pain than acetaminophen, meclofenamate, aceclofenac, bromfenac, and aspirin. Moreover, ibuprofen and traditional non-steroidal anti-inflammatory drugs have a similar safety profile. In conclusion, ibuprofen 400 mg appears to have good analgesic efficacy and a safety profile similar to other traditional non-steroidal anti-inflammatory drugs after third molar surgery.

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Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years

Cited by 71 publications

References 56 publications

Effects of Acetaminophen or Ibuprofen Monotherapy in Febrile Children: A Meta-Analysis of Randomized Controlled Trials

Effects of Acetaminophen or Ibuprofen Monotherapy in Febrile Children: A Meta-Analysis of Randomized Controlled Trials

Paracetamol exposure and asthma: What does the evidence say? An overview of systematic reviews

A Meta-Analysis of the Analgesic Efficacy of Single-Doses of Ibuprofen Compared to Traditional Non-Opioid Analgesics Following Third Molar Surgery

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