Evaluate the evidence comparing the effectiveness of paracetamol and ibuprofen
Study evaluates the effectiveness of paracetamol versus ibuprofen administration in febrile children.
Narayan K, Cooper S, Morphet J et al (2017) Effectiveness of paracetamol versus ibuprofen administration in febrile children: A systematic literature review. Journal of Paediatrics and Child Health. 53, 8, 800-807. doi:10.1111/jpc.13507
The aim of the systematic literature review was to evaluate the evidence comparing the effectiveness of paracetamol and ibuprofen in the treatment of fever in children.
Only randomised controlled trials (RCTs) were included in the systematic literature review; these involved children aged from one month to 12 years presenting with a temperature of between 37.5 and 41°C inclusive. Research papers were excluded if the RCTs investigated critically ill children, adolescents and adults. A total of eight RCTs were included in this systematic literature review.
Paracetamol and ibuprofen are effective in reducing fever in children. Results of the review also demonstrated that ibuprofen monotherapy was slightly better at reducing fever and distress in children compared to paracetamol monotherapy; although this lacked statistical significance. Ibuprofen was also found to have the potential to produce a greater mean fall in temperature clearance over extended time periods due to the longer duration of its action. Parents identified paracetamol as first choice antipyretic in the home.
There is little evidence to support the superior efficacy of paracetamol or ibuprofen in treating fever in children, therefore they must be considered as equally effective. The generalisability was limited as the included studies incorporated a variety of drug doses, temperature measurement routes, age ranges and additional drugs. Therefore, further research involving a larger sample size, uniform dosages and age controls is recommended for a definitive conclusion.
Understanding fever associated distress and the effectiveness of paracetamol and ibuprofen
Fever is a normal physiological response to infection where the body’s temperature becomes elevated above the normal range in reaction to pathogens or disease. Most cases of fever are caused by self-limiting viral illnesses that can be managed at home safely with minimal intervention. However, the National Institute for Health and Care Excellence (NICE) (2017) states that fever in children under five is the second most common reason for admission to hospital.
NICE (2017) guidelines govern the management of fever in practice and in the home, focusing on the under-fives. It is advised that antipyretics should not be administered with the sole intention of reducing body temperature but to be given if the feverish child appears distressed. Paracetamol and ibuprofen are not to be given simultaneously, they can however be used alternately if the distress persists.
Out of the eight studies in the systematic review only three investigated fever associated distress. There is often parental anxiety with a feverish child with many believing a fever can cause brain damage and seizures which further alters the perception of their child’s distress (McDougall and Harrison 2014, Teagle and Powell 2014). This may affect a parent’s decision about when they administer an antipyretic, which drug to choose and when to seek medical help. This systematic review highlights the need for further research into the role of antipyretics in distressed febrile children and places an emphasis on interventions in practice to improve health professionals’ and parents’ understanding of fever and its management. There is a need for further education on fever associated distress so nurses and parents are more confident in its recognition and treatment.
- McDougall P, Harrison M (2014) Fever and feverish illness in children under five years. Nursing Standard. 28, 30, 49-59.
- National Institute for Health and Care Excellence (2017) Fever in under 5s: assessment and initial management.
- Teagle AR, Powell CV (2014) Is fever phobia driving the inappropriate use of antipyretics? Archives of Disease in Childhood. 99, 701-702. doi: 10.1136/archdischild-2013-305853
Compiled by Louise Bowden, teaching and learning intern for children and young people’s nursing at the University of Salford, on behalf of the RCN’s Research in Child Health community