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Ibuprofen Is Superior to Acetaminophen for Treating Childhood Fever

Ibuprofen, with or without acetaminophen, was more effective than acetaminophen alone for reducing fever in children aged 6 months to 6 years.

Advising parents of children with fever is a daily occurrence in emergency departments. Researchers in England performed a randomized, blinded, controlled trial to compare ibuprofen (10 mg/kg every 6 to 8 hours), acetaminophen (15 mg/kg every 4 to 6 hours), and combination therapy for relieving fever and discomfort in 156 outpatients aged 6 months to 6 years with axillary temperatures of 37.8°C–41.0°C.

During the first 4 hours after administration of the first dose, ibuprofen plus acetaminophen was superior to acetaminophen alone for time without fever and similar to ibuprofen alone. During the first 24 hours, children who received combination therapy had 4.4 more hours without fever than those who received acetaminophen alone and 2.5 more hours without fever than those treated with ibuprofen alone, and children who received ibuprofen alone had 1.9 more hours without fever than those who received acetaminophen alone. No differences in the proportions of children with discomfort at 48 hours or other fever-associated symptoms were noted among groups. Side effects were minor and similar in incidence among groups. Parents exceeded the maximum 24-hour recommended doses in 6% to 13% of cases.

Comment: Parents of children with fever should be advised about the importance of hydration and use of cool clothing and should be reassured that fever itself is not harmful and might even be beneficial, as noted in an accompanying editorial. However, when fever reduction is the goal, the findings suggest that ibuprofen should be first-line therapy because it reduces fever faster and for longer periods than does acetaminophen. Combination therapy also can be considered, but the complexity of giving both drugs could lead to dosing confusion, making ibuprofen alone preferable.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine October 17, 2008

Citation(s):

Hay AD et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): Randomised controlled trial. BMJ 2008 Sep 2; 337:a1302. (http://dx.doi.org/10.1136/bmj.a1302)

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• Medline abstract (Free)

Harnden A. Antipyretic treatment for feverish young children in primary care. BMJ 2008 Sep 2; 337:a1409. (http://dx.doi.org/10.1136/bmj.a1409)

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• Medline abstract (Free)