Examining the efficacy and safety of ibuprofen versus acetaminophen

When a child is in pain or has a fever, most parents will turn to either ibuprofen or acetaminophen to bring relief. A meta-analysis in JAMA Network Open looked at the analgesic and antipyretic qualities of both as well as the safety profiles.¹

The researchers ran a systematic search in MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials, as well as the Australian New Zealand Clinical Trials Registry and ClinicalTrials.gov. Any study that looked at children aged younger than 2 years and was comparing acetaminophen to ibuprofen, and reporting antipyretic, analgesic, and/or safety outcomes were considered. Two researchers independently extracted the data and assessed the quality.

There were 19 studies included in the meta-analysis and the studies covered 241,138 participants. The studies came from 7 different countries and included both hospital- and community-based health care settings. When compared with acetaminophen, they found that ibuprofen 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) as well as 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). When looking at the analgesic quality of ibuprofen, they also found that ibuprofen had 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) when compared to acetaminophen. Overall, adverse events were infrequent. Both ibuprofen and acetaminophen seem to have similar serious adverse event profiles (7 studies with 27,932 participants; ibuprofen vs acetaminophen: odds ratio, 1.08; 95% CI, 0.87-1.33; P = .50, I2 = 0%; moderate-quality evidence).

They concluded that ibuprofen was more linked to reduced temperature and pain within the first 21 hours than acetaminophen. However, they noted that there were limited data on long-term adverse events and younger infants. The investigators believe that further large, randomized trials could provide more information on both medications and infants aged younger than 6 years as well as further exploring the adverse effects of both.

Reference

1. Tan E, Braithwaite I, McKinlay C, Dalziel S. Comparison of acetaminophen (paracetamol) with ibuprofen for treatment of fever or pain in children younger than 2 years: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(10):e2022398. doi:10.1001/jamanetworkopen.2020.22398