New research has shown that ibuprofen is more effective at reducing fever and pain in children under two years of age within the first 24 hours of treatment.
Paracetamol (acetaminophen) and ibuprofen are the most widely prescribed and available over-the-counter medications for the management of fever and pain in children, with data suggesting up to 95% of children aged nine months and over as being exposed to acetaminophen.
But according to the authors of a new study, research on the effectiveness of these drugs is lacking and treatment recommendations for young children ‘remain divergent‘, especially in children under six months.
In addition, although acetaminophen is often considered the first line in the treatment of fever and pain in children due to its supposedly superior safety profile, there is growing evidence suggest that the use of acetaminophen in children is associated with increased risk to develop asthma and related atopic diseases.
In an effort to assist clinicians, the authors set out to compare the “antipyretic, analgesic and safety profiles” of acetaminophen with ibuprofen for the short-term treatment of fever or pain in children of less than two years.
To do this, they conducted a meta-analysis of 19 studies involving 241,138 participants, from which the researchers determined that ibuprofen was associated with reduced temperature within four hours and 4 to 24 hours after treatment. , as well as less pain at 4 to 24 hours. .
‘[There is] a statistical advantage at less than four hours and at 4 to 24 hours of ibuprofen over acetaminophen when used for fever, âthe researchers wrote.
‘Although the [standardised mean differences] were small, this benefit extended to the categorical results, with children receiving ibuprofen being approximately twice as likely to be afebrile at these stages. ‘
Previous studies cautioned against the use of ibuprofen in younger infants, citing a higher risk of acute kidney injury, in particular within the framework of dehydration, compared to acetaminophen. But the researchers “found no evidence to support this view” and concluded that the two drugs had equivalent short-term safety profiles, with “very low rates” of adverse reactions overall. .
However, more research is needed to draw more solid conclusions in some areas.
âConcerns have been expressed that the use of ibuprofen may increase the risk of severe bacterial infection in children, in particular, invasive group A streptococcus [GAS] skin infection as part of the primary infection chickenpox infection and empyema. We found insufficient evidence to support or refute these hypotheses, âthe authors wrote.
âLarge randomized trials are needed to fill these knowledge gaps, designed to include and report on the subgroup of infants under six months of age and to study the safety of acetaminophen and ibuprofen such as primary endpoint, with long-term follow-up and monitoring for adverse events. ‘
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