Ibuprofen better than acetaminophen as antipyretic in young kids: JAMA

Acetaminophen (paracetamol) and ibuprofen are the most widely prescribed and available over-the-counter medications for management of fever and pain in children. Despite the common use of these medications, treatment recommendations for young children remain divergent, especially among those younger than 6 months. While acetaminophen is uniformly recommended across countries for use from the neonatal period, the maximum daily dose beyond the neonatal period varies from 60 mg/kg/d to 90 mg/kg/day.Recommendations for ibuprofen use for the treatment of fever and pain in young children are considerably more variable.

Although acetaminophen is often considered first-line in the treatment of fever and pain in children because its safety is perceived to be more assured, there is growing evidence suggesting acetaminophen use in children is associated with an increased risk of developing asthma and related atopic disease.

With this background, researchers undertook a study to compare acetaminophen with ibuprofen for the short-term treatment of fever or pain in children younger than 2 years.

Studies of any design that included children younger than 2 years and directly compared acetaminophen with ibuprofen, reporting antipyretic, analgesic, and/or safety outcomes were considered. There were no limits on length of follow-up. The primary outcomes were fever or pain within 4 hours of treatment onset. Safety outcomes included serious adverse events, kidney impairment, gastrointestinal bleeding, hepatotoxicity, severe soft tissue infection, empyema, and asthma and/or wheeze.

On data analysis, the following key facts emerged.

• Overall, 19 studies (11 randomized; 8 nonrandomized) of 241 138 participants from 7 countries and various health care settings (hospital-based and community-based) were included.
• Compared with acetaminophen, ibuprofen resulted in reduced temperature at less than 4 hours (4 studies with 435 participants; standardized mean difference [SMD], 0.38; 95% CI, 0.08-0.67; P = .01; I² = 49%; moderate quality evidence) and at 4 to 24 hours (5 studies with 879 participants; SMD, 0.24; 95% CI, 0.03-0.45; P = .03; I² = 57%; moderate-quality evidence) and less pain at 4 to 24 hours (2 studies with 535 participants; SMD, 0.20; 95% CI, 0.03-0.37; P = .02; I² = 25%; moderate-quality evidence).
• Adverse events were uncommon.

"These findings are supported by similar results from previous systematic reviews involving older children, while adding to the body of evidence on the antipyretic, analgesic, and safety profiles of acetaminophen and ibuprofen in children younger than 2 years of age."concluded the team.

Forthe full article ,follow the link:10.1001/jamanetworkopen.2020.22398

Primary source:JAMA Open Network