Antipyretic efficacy of ibuprofen and acetaminophen in children with febrile seizures
A. Van Esch, H. A. Van Steensel-Moll, E. W. Steyerberg, M. Offringa, J. D. Habbema and G. Derksen-Lubsen
Department of Pediatrics, University Hospital, Rotterdam, The Netherlands.
OBJECTIVE: To compare the antipyretic efficacy of ibuprofen syrup (5 mg/kg
per dose) and acetaminophen syrup (10 mg/kg per dose) in children with a
history of febrile seizures. DESIGN: Randomized, multiple-dose,
double-blind, cross-over trial. SETTING: The outpatient department of a
university-affiliated teaching hospital. PATIENTS: Seventy outpatients
(mean age, 2.1 years; range, 10 months to 4 years) who had visited the
hospital because of a febrile seizure were randomized to treatment at a
temperature of 38.5 degrees C or higher. INTERVENTIONS: Study medication
was given every 6 hours for 1 to 3 days. Rectal temperatures were recorded
at 0, 2, 4, 6, 12, and 24 hours after the first dose. MAIN OUTCOME
MEASURES: The temperature 4 hours after the first dose, the mean
temperature during treatment, and the highest temperature during treatment
were evaluated. Analysis of covariance corrected for the initial
temperature, age, weight, and cause of the fever. RESULTS: Ibuprofen
lowered the initial temperature from 39.1 degrees C to a mean temperature
of 37.7 degrees C during treatment; acetaminophen lowered the initial
temperature from 39.2 degrees C to 38.0 degrees C. Ibuprofen reduced fever
0.50 degree C more than did acetaminophen at 4 hours (95% confidence
interval [CI], -0.98 to -0.02). The mean temperature was 0.26 degree C
lower during ibuprofen treatment (95% CI, -0.59 to 0.07); the highest
temperature was 0.30 degree C lower (95% CI, -0.73 to 0.13). In 22
patients, a second fever was treated with the opposite medication than the
first. In the cross-over analysis, the respective differences were 0.66
degree C (95% CI, -1.29 to -0.06), 0.40 degree C (95% CI, -0.83 to 0.03),
and 0.36 degree C (95% CI, -0.81 to 0.08) in favor of ibuprofen.
CONCLUSIONS: Ibuprofen and acetaminophen are effective antipyretic agents
in children with a history of febrile seizures. Ibuprofen yielded
significantly greater fever reduction than did acetaminophen 4 hours after
the first dose. Research is needed on the value of antipyretic agents for
the prevention of febrile seizure recurrence.
