Ibuprofen superior to paracetamol for young children: Study

Paracetamol (acetaminophen) and ibuprofen are the most widely prescribed and available over-the-counter medications for 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 into the effectiveness of these medications is lacking and treatment recommendations for young children ‘remain divergent’, especially among those younger than six months.
 
Additionally, even though acetaminophen is often considered first-line in the treatment of fever and pain in children because of its supposedly superior safety profile, there is growing evidence to suggest acetaminophen use in children is associated with an increased risk of developing asthma and related atopic disease.
 
In an effort to aid clinicians, the authors set about comparing the ‘antipyretic, analgesic, and safety profiles’ of acetaminophen with ibuprofen for the short-term treatment of fever or pain in children younger than two years.
 
To do this, they conducted a meta-analysis of 19 studies involving 241,138 participants, from which the researchers determined ibuprofen was associated with reduced temperature at less than four hours and 4–24 hours after treatment, along with less pain at 4–24 hours.
 
‘[There is] a statistical benefit at less than four hours and at 4–24 hours of ibuprofen compared with acetaminophen when used for fever,’ the researchers wrote.
 
‘Although the [standardised mean differences] were small, this benefit extended to categorical outcomes with children receiving ibuprofen being approximately twice as likely to be afebrile at these points.’
 
Previous studies have cautioned against the use of ibuprofen in younger infants, citing a higher risk of acute kidney injury, particularly in the context of dehydration, when compared with acetaminophen. But the researchers ‘did not find any evidence to support this view’ and concluded both medications have equivalent safety profiles in the short term, with ‘very low rates’ of adverse reactions overall.
 
However, more research is needed to form stronger conclusions in some areas.
 
‘Concern has been raised that ibuprofen use may increase the risk of serious bacterial infection in children, specifically, invasive group A streptococcal [GAS] skin infection in the context of primary varicella infection and empyema. We found insufficient evidence to support or refute these hypotheses,’ the authors wrote.
 
‘Large, randomised trials are needed to address these knowledge gaps, designed to include and report on the subgroup of infants younger than six months and to investigate the safety of acetaminophen and ibuprofen as a primary end point, with long-term follow-up and monitoring for adverse events.’
 
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