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Acetaminophen vs. Ibuprofen: Take Which and Call Me in the Morning?

A meta-analysis re-examines safety and efficacy assumptions and identifies the better fever fighter.

Most practitioners have established patterns in their recommendation of either acetaminophen or ibuprofen for relief of fever and pain. Treatment decisions are often based on concerns about side effects or parental preferences. To better elucidate the pros and cons of each agent for single-dose usage, researchers undertook a meta-analysis of 17 randomized, controlled trials of these drugs in children (age, <18 years): 3 articles were included in the pain relief analysis, 10 in the fever reduction analysis, and all 17 in the safety analysis.

Both drugs were equally efficacious for pain relief. Ibuprofen was a more effective antipyretic at 2, 4, and 6 hours after treatment and demonstrated the best results when used at a dosage of 10 mg/kg. The safety profiles of these drugs did not differ from each other or placebo.

Comment: These findings confirm previous reports suggesting that ibuprofen is a superior antipyretic. Although both drugs were equally effective for controlling pain, we do not yet know whether they differ in efficacy for specific types of pain. Many physicians still choose acetaminophen because of concern about the safety of nonsteroidal agents, but for single use, either drug is probably safe. It is critical to keep in mind that a more potent antipyretic may create a false sense of security. In addition to treating symptoms, we need to search for the source of pain or fever and monitor the patient's overall progress carefully.

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 26, 2004

Citation(s):

Perrott DA et al. Efficacy and safety of acetaminophen vs ibuprofen for treating children's pain or fever: A meta-analysis. Arch Pediatr Adolesc Med 2004 Jun; 158:521-6.

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