Which is better to use when treating children with fever or pain, acetaminophen or ibuprofen? According to a recent meta-analysis, the answer depends on what one wants to accomplish: for fever reduction, ibuprofen appears to be more effective. The drugs appear to have similar pain-relieving capabilities and when only one dose is used, they both appear to be safe, although the results aren't conclusive.
Within four hours of a single dose, fever reduction was accomplished in 38% more children who were given ibuprofen (5 to 10 mg/kg) than in children given acetaminophen (10 to 15 mg/kg), and when only those studies using ibuprofen at the higher dose were analyzed, that drug's antipyretic effects were even more pronounced. Studies of the relief of mild-to-moderate pain after a singe dose (ibuprofen 4 to 10 mg/kg and acetaminophen 7 to 15 mg/kg) revealed that the drugs' effects were comparable.
Data on safety, however-particularly regarding abdominal pain and vomiting, two important concerns with ibuprofen administration-were inconclusive, primarily because the researchers examined the effects of single doses of the drugs.
The analysis had several limitations. Ill children commonly receive several doses of acetaminophen or ibuprofen over 24 hours or longer, so the relative efficacy and safety under the conditions in which these two drugs are most commonly used are still unknown. In addition, the researchers had determined that only 17 studies were of high enough quality to be included in the analysis, and sample sizes in many of the studies were small. They also used "standardized effects" in their analysis, in order to include studies that employed different outcome measurements, a technique heavily criticized in an editorial appearing in the same journal issue.
While there is a need for larger, randomized, controlled trials comparing acetaminophen and ibuprofen use in children, it seems reasonable to use ibuprofen first when a child is in need of rapid fever reduction and has no contraindications to its use. -Fran Mennick, BSN, RN
Perrott DA, et al. Arch Pediatr Adolesc Med 2004;158(6):521-6
Cummings P. Arch Pediatr Adolesc Med 2004;158(6):595-7.