Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Ibuprofen vs. Acetaminophen for Fever or Pain in Children Younger Than Two Years

 

Am Fam Physician. 2021 May 1;103(9):online.

image

 Enlarge     Print

IBUPROFEN VS. ACETAMINOPHEN FOR CHILDREN YOUNGER THAN TWO YEARS

BenefitsHarms

Ibuprofen lowered temperature (standardized mean difference = 0.38°C [0.21°F]) more than acetaminophen within four hours

No one was harmed

1 in 8 receiving ibuprofen vs. acetaminophen was afebrile within four hours

1 in 6 receiving ibuprofen vs. acetaminophen was afebrile at four to 24 hours

1 in 4 receiving ibuprofen vs. acetaminophen had reduced pain at four to 24 hours

12.5% reduction in fevers within four hours with ibuprofen vs. acetaminophen

18.5% reduction in fevers at four to 24 hours with ibuprofen vs. acetaminophen

25.2% reduction in pain at four to 24 hours with ibuprofen vs. acetaminophen

IBUPROFEN VS. ACETAMINOPHEN FOR CHILDREN YOUNGER THAN TWO YEARS

BenefitsHarms

Ibuprofen lowered temperature (standardized mean difference = 0.38°C [0.21°F]) more than acetaminophen within four hours

No one was harmed

1 in 8 receiving ibuprofen vs. acetaminophen was afebrile within four hours

1 in 6 receiving ibuprofen vs. acetaminophen was afebrile at four to 24 hours

1 in 4 receiving ibuprofen vs. acetaminophen had reduced pain at four to 24 hours

12.5% reduction in fevers within four hours with ibuprofen vs. acetaminophen

18.5% reduction in fevers at four to 24 hours with ibuprofen vs. acetaminophen

25.2% reduction in pain at four to 24 hours with ibuprofen vs. acetaminophen

Details for This Review

Study Population: 241,138 patients younger than two years from 18 studies who received acetaminophen or ibuprofen for fever or pain

Efficacy End Points: Reduction in temperature or pain within four hours and four to 24 hours

Harm End Points: Serious adverse events, renal impairment, gastrointestinal bleeding, liver injury, severe soft tissue infection, empyema, and asthma or wheezing

Narrative: Fever and pain are common in childhood. Acetaminophen and ibuprofen are the most widely used medications to treat these conditions, with up to 95% of children receiving acetaminophen by nine months of age.1 The decision to use ibuprofen or acetaminophen for fever or pain typically varies based on purported benefits and harms, and recommendations regarding these medications differ in terms of age and dosing.2,3

Several older studies suggest that acetaminophen is safer because ibuprofen was associated with an increased risk of acute kidney injury and serious bacterial infection or soft tissue infection.49 However, more recent evidence suggests early acetaminophen exposure may be associated with childhood asthma.10,11 Previous meta-analyses have suggested that ibuprofen is likely more effective than acetaminophen for fever and at least as effective as acetaminophen for pain relief, with no difference in adverse events.12,13 These earlier reviews had significant heterogeneity and included ages one month to 18 years, limiting the applicability to children younger than two years.

The meta-analysis in this review included studies of any design and children younger than two years; directly compared acetaminophen with ibuprofen; and reported antipyretic, analgesic, and/or safety outcomes.14 Primary outcomes were fever (continuous variable) or pain within four hours of treatment. Secondary outcomes included the proportion of patients who were fever-free or pain-free within

Author disclosure: No relevant financial affiliations.


Copyright ©2021 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

show all references

1. Morton SMB, Atatoa Carr PE, Grant CC, et al. Cohort profile: growing up in New Zealand. Int J Epidemiol. 2013;42(1):65–75....

2. Sullivan JE, Farrar HC; Section on Clinical Pharmacology and Therapeutics; Committee on Drugs. Fever and antipyretic use in children. Pediatrics. 2011;127(3):580–587.

3. Joint Formulary Committee. British National Formulary for children. Accessed October 10, 2020. https://bnfc.nice.org.uk

4. Ziesenitz VC, Zutter A, Erb TO, et al. Efficacy and safety of ibuprofen in infants aged between 3 and 6 months. Paediatr Drugs. 2017;19(4):277–290.

5. de Martino M, Chiarugi A, Boner A, et al. Working towards an appropriate use of ibuprofen in children: an evidence-based appraisal. Drugs. 2017;77(12):1295–1311.

6. Misurac JM, Knoderer CA, Leiser JD, et al. Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. J Pediatr. 2013;162(6):1153–1159.

7. Mikaeloff Y, Kezouh A, Suissa S. Nonsteroidal anti-inflammatory drug use and the risk of severe skin and soft tissue complications in patients with varicella or zoster disease [published correction appears in Br J Clin Pharmacol. 2010;69(6): 722]. Br J Clin Pharmacol. 2008;65(2):203–209.

8. Le Bourgeois M, Ferroni A, Leruez-Ville M, et al.; Children, Antibiotics, Nonsteroidal Anti-inflammatory Drugs and Childhood Empyema (ChANCE) Study Group. Nonsteroidal anti-inflammatory drug without antibiotics for acute viral infection increases the empyema risk in children: a matched case-control study. J Pediatr. 2016;175:47–53.e3.

9. Goldman RD. Efficacy and safety of acetaminophen versus ibuprofen for treating children's pain or fever: a meta-analysis. J Pediatr. 2005;146(1):142–143.

10. Garcia-Marcos L, Sanchez-Solis M, Perez-Fernandez V. Early exposure to acetaminophen and allergic disorders. Curr Opin Allergy Clin Immunol. 2011;11(3):162–173.

11. Kanabar D, Dale S, Rawat M. A review of ibuprofen and acetaminophen use in febrile children and the occurrence of asthma-related symptoms. Clin Ther. 2007;29(12):2716–2723.

12. Perrott DA, Piira T, Goodenough B, et al. Efficacy and safety of acetaminophen vs ibuprofen for treating children's pain or fever: a meta-analysis. Arch Pediatr Adolesc Med. 2004; 158(6):521–526.

13. Pierce CA, Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. Ann Pharmacother. 2010;44(3):489–506.

14. Tan E, Braithwaite I, McKinlay CJD, et al. Comparison of acetaminophen (paracetamol) with ibuprofen for treatment of fever or pain in children younger than 2 years: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(10):e2022398.

 

 

Copyright © 2021 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Sep 2021

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article