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Efficacy and Safety of Acetaminophen vs Ibuprofen for Treating Children's Pain or Fever
A Meta-analysis
David A. Perrott, PhD;
Tiina Piira, MPsychol;
Belinda Goodenough, PhD;
G. David Champion, MD
Arch Pediatr Adolesc Med. 2004;158:521-526.
Objective To summarize studies testing the efficacy and safety of single-dose acetaminophen and ibuprofen for treating children's pain or fever.
Data Sources Reports were gathered by searching computerized databases (from their inception through May 2002) and registries, relevant journals, and bibliographies of key articles.
Study Selection Seventeen blinded, randomized controlled trials with children (<18 years) receiving either drug to treat fever or moderate to severe pain.
Data Extraction 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.
Data Synthesis 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).
Conclusions 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.
From the Pain Research Unit, Sydney Children's Hospital, Randwick, New South Wales, Australia (Drs Perrott, Goodenough, and Champion, and Ms Piira); Department of Psychology, Northwestern University, Evanston, Ill (Dr Perrott); School of Psychology, University of New South Wales (Ms Piira and Dr Goodenough), and the Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital (Dr Goodenough), Randwick. Dr Perrott is now with TrialGraphix, Chicago, Ill.
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