Efficacy and safety of acetaminophen vs ibuprofen for treating children's pain or fever: a meta-analysis

• Published in: Archives of pediatrics & adolescent medicine Vol. 158; no. 6; p. 521
• Main Authors: Perrott, David A, Piira, Tiina, Goodenough, Belinda, Champion, G David
• Format: Journal Article
• Language: English
• Published: United States 01-06-2004
• Subjects: Acetaminophen - therapeutic use; Adolescent; Analgesics, Non-Narcotic - therapeutic use; Child; Child, Preschool; Fever - drug therapy; Humans; Ibuprofen - therapeutic use; Infant; Infant, Newborn; Odds Ratio; Pain - drug therapy; Randomized Controlled Trials as Topic; Treatment Outcome
• ISSN: 1072-4710
• DOI: 10.1001/archpedi.158.6.521

To summarize studies testing the efficacy and safety of single-dose acetaminophen and ibuprofen for treating children's pain or fever.
Reports were gathered by searching computerized databases (from their inception through May 2002) and registries, relevant journals, and bibliographies of key articles.
Seventeen blinded, randomized controlled trials with children (<18 years) receiving either drug to treat fever or moderate to severe pain.
Under a fixed-effects model, outcome measures for an initial single dose of ibuprofen vs acetaminophen were the risk ratio for achieving more than 50% of maximum pain relief, effect size for febrile temperature reduction, and risk ratio for minor and major harm.
Ibuprofen (4-10 mg/kg) and acetaminophen (7-15 mg/kg) showed comparable efficacy (3 pain relief trials; 186 children). The risk ratio point estimates was 1.14 (95%confidence interval [CI], 0.82-1.58) at 2 hours after receiving the dose, and 1.11 (95% CI, 0.89-1.38) at 4 hours. Ibuprofen (5-10 mg/kg) reduced temperature more than acetaminophen (10-15 mg/kg) at 2, 4, and 6 hours after treatment (respective weighted-effect sizes: 0.19 [95% CI, 0.05-0.33], 0.31 [95% CI, 0.19-0.44], and 0.33 [95% CI, 0.19-0.47]) (9 fever trials; 1078 children). For ibuprofen 10 mg/kg (acetaminophen, 10-15 mg/kg), corresponding effect sizes were 0.34 (95% CI, 0.12-0.56), 0.81 (95% CI, 0.56-1.03), and 0.66 (95% CI, 0.44-0.87). There was no evidence the drugs differed from each other (or placebo) in incidence of minor or major harm (17 safety trials; 1820 children).
In children, single doses of ibuprofen (4-10 mg/kg) and acetaminophen (7-15 mg/kg) have similar efficacy for relieving moderate to severe pain, and similar safety as analgesics or antipyretics. Ibuprofen (5-10 mg/kg) was a more effective antipyretic than acetaminophen (10-15 mg/kg) at 2, 4, and 6 hours posttreatment.