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Acetaminophen, Ibuprofen Equally Safe and Effective for Pain Relief in Children, but Ibuprofen Appears Superior for Fever Reduction

Acetaminophen and ibuprofen are equally effective for treating pain and have similar safety profiles in children, but ibuprofen appears to be more effective in reducing fever than is acetaminophen, according to the findings of a meta-analysis.

David Perrott, PhD, Department of Psychology, Northwestern University, Evanston, Illinois, United States, and colleagues conducted a meta-analysis of randomised controlled trials, completed before May 2002 in children, less than 18 years old treated with either acetaminophen or ibuprofen for fever or moderate to severe pain.

The investigators used a fixed-effects model to measure outcomes of a single initial dose of either medication on achieving a 50% reduction in pain, reduction in fever, and a risk ratio for minor and major harm, as reported in 17 trials.

In 3 trials comparing pain relief in 186 children, a 7 to 15 mg/kg dose of acetaminophen and a 4 to 10 mg/kg dose of ibuprofen showed similar efficacy, with risk ratio point-estimates of 1.14 at 2 hours and 1.11 at 4 hours.

A total of 9 trials, including 1078 children, assessed fever reduction. These results show that 5 to 10 mg/kg ibuprofen reduced temperature more than 10 to 15 mg/kg acetaminophen, for weighted-effect sizes of 0.19 at 2 hours, 0.31 at 4 hours, and 0.33 at 6 hours after treatment. In a more focused analysis of only studies comparing 10 mg/kg dosages of each medication to each other, "the point-estimates in favour of ibuprofen were approximately twice as large," the authors write.

The safety analysis included all 17 trials, with a total of 1820 children. The point-estimate for the risk ratio for minor harm was 0.96 and for major harm was 1.00, indicating the medications did not differ from each other in safety. In the 9 studies with a placebo arm, the risk ratio for acetaminophen versus placebo was 0.79, and for ibuprofen versus placebo was 1.17 for minor harm. The risk ratios for major harm were 0.90 for acetaminophen versus placebo, and 1.51 for ibuprofen versus placebo. The authors note that the 95% confidence intervals were wide for these comparisons making these data inconclusive as to safety.

"The logical implication for practice of the present meta-analysis is that when pediatric antipyresis is appropriate, 5 to 10 mg/kg of ibuprofen should be generally preferred over 10 to 15 mg/kg of acetaminophen for short-term use," the authors conclude. "For pediatric analgesia, these data do not support a clear preference for one drug over the other; both were more effective than placebo and equally safe at the studied dosages."


Arch Pediatr Adolesc Med. 2004;158:521-526

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