University of the

Witwatersrand
Department of Paediatrics
Division of Community Paediatrics
Assignment A: Is Ibuprofen Better Than Paracetamol
in Reducing Fever?

Ayesha Bibi Khan

 Pyrexia Reduction Using Ibuprofen and Paracetamol
Title

Is ibuprofen better than paracetamol at reducing pyrexia?

Scenario

A 10 year old boy presents with a history of dyspnoea and cough of five days duration.
Clinical examination revealed features suggestive of multi-lobar pneumonia, including
collapse and consolidation of the right upper, left upper and left lower lobes. Following
admission he developed a spiking temperature which was treated using paracetamol. His
pyrexia continued for several days. I wondered if using ibuprofen would have been more
beneficial in reducing his pyrexia.

Clinical Question

In children presenting with a significant fever, is ibuprofen better than paracetamol at

controlling pyrexia?

Search Strategy

Cochrane Database of Systematic Reviews and Pubmed:

Search criteria: Ibuprofen +paracetamol +fever
Limits:All child 0-18yrs
English
Abstracts
Human
Search outcome:
Cochrane – One hit which was irrelevant
Pubmed –
41 hits
 10 relevant
 31 irrelevant, relating either to adults, pyrexia control or pharmacologic
and other topics.
 Author, date and Study type (level of
Patient group Outcomes Key results Study weaknesses
country evidence)
Similar results obtained for degree & rate of
Rate of temp ↓
temp ↓ for both groups
Degree of temp↓
Sheth UK et al 1980 22 children Not available Ibuprofen has greater efficacy in terms of Small numbers
Duration of ↓ in
duration of action
temp, over 12h
Walson PD et al 1989 127 children aged Double-blind randomised Rate of temp ↓, Efficacy of high-dose & low-dose ibuprofen is
USA 2-11yrs control over 12h greater than paracetamol
Drop in temp similar in both groups
Joshi YM et al 1990 175 children aged Degree of temp↓ Only tested over
Open multi-centric trial At half hour paracetamol greater drop than
India 4mo-12yrs ½ hrly for 2h 2h
ibuprofen
Kauffmann RE et al 37 children aged 2- Double-blind randomised Degree of temp↓ Ibuprofen produced a greater temp decrement &
Small numbers
1992 USA 12yrs placebo-control study at 30min & 8h longer duration of antipyresis than paracetamol
Khubchandani RP et 87 children aged 1- Degree of temp↓, Mefenamic acid>ibuprofen>paracetamol in
Randomised controlled Unblinded
al 1995 India 7yrs over 4h degree of antipyresis
Mean temp
Children in Double-blind parallel change efficacy
McIntrye J et al 1996 No significant difference between paracetamol
paediatric ward group multiple dose study at 4h
England and ibuprofen
aged 2mo-12yrs (level 1b) Change in
clinical condition
Unblinded
Autret E et al 1997 Children aged 6- Ibuprofen had greater efficacy than paracetamol
Open randomised % temp ↓ Aspirin in
France 24mo and aspirin.
children!
Rate of temp ↓
Ibuprofen demonstrated greater efficacy than
Vauzelle-Kervroedan 116 children aged Double-blind randomised Degree of temp ↓
paracetamol, but this was not statistically
F et al 1997 France 2-8yrs control (level 1b) Duration of ↓ in
significant.
temp, over 6h
Ibuprofen was better than paracetamol at
Modified Double-blind Degree of temp↓
Wong A et al 2001 555 children aged temperature normalisation
randomised multi-national Duration of ↓ in
Brazil 6mo-6yrs Dipyrone had a longer duration of action than
trial (level 1b) temp, over 4-6h
either ibuprofen or paracetamol
Change in 12 children
Figueras Nadal C et al Double-blind randomised
199 children tympanic temp Ibuprofen showed a greater degree of temp ↓. discontinued use
2002 Spain controlled trail multicentric
over 4h d/t SE

Summary of Relevant Papers

Commentary

At first glance it seems that an equal number of studies found ibuprofen as efficacious as
paracetamol, and ibuprofen superior to paracetamol. However, on closer inspection and
analysis of the evidence, ibuprofen is clearly superior to paracetamol.

Controlled studies by Walson et al and others show that ibuprofen has greater anti-
pyrexial efficacy than paracetamol. However, this is opposed by the studies by, amongst
others, Sheth et al, which claim paracetamol to be equally efficacious to ibuprofen.
Caution is required when interpreting the Sheth et al study because the numbers studied
are too few to be statistically significant. McIntyre et al did not provide figures of the
number of patients treated, and so one must also approach this study with reserve. Most
studies, it seems, were conducted over a reasonable period of time (4 – 8 hrs); Joshi et al
only conducted their study over two hours. Not withstanding the onset of action of the
drugs, this time frame is insufficient to make a comment on the efficacy of the drugs,
since acute fluctuations in temperature may skew the results in either direction.

The rate of temperature decrease is more impressive, especially in Walson et al and

Wong et al. These studies are well structured (double-blind and randomised control trial),
and have an adequate number of participants to be able to draw reasonable conclusions
from, as well as increasing their reliability.

The duration of action of ibuprofen surpasses that of paracetamol according to Seth et al,
Kauffmann et al and Vauzelle-Kervroeden et al. The evidence is not very convincing as
the former two studies have insufficient numbers to draw conclusions from, and the latter
claims no statistical significance, even though ibuprofen is proven to act longer than
paracetamol. No studies directly oppose these findings.

It can thus be concluded that the efficacy of ibuprofen in terms of degree, rate and
duration of action is superior to that of paracetamol. It should be noted that several
studies show that tolerability was similar with both drugs Regardless, the safety profile of
ibuprofen is less impressive than paracetamol (this is a separate topic and will not be
discussed further here).

Clinical Bottom Line

Ibuprofen is better than paracetamol for reducing fever in children.

References
1. Sheth UK, Gupta K, Paul T et al. Measurement of antipyretic activity of ibuprofen
and paracetamol in children. J Clin Pharmacol. 1980;20:672-5
2. Walson PD, Galletta G, Braden NJ et al. Ibuprofen, acetaminophen, and placebo
treatment of febrile children. Clin Pharm Therapeutics 1989;46:9-17.
3. Joshi YM, Sovani VB, Joshi VV et al. Comparative evaluation of the antipyretic
efficacy of ibuprofen and paracetamol. Indian Pediatr 1990;27:803-6.
4. Kauffman RE, Sawyer LA, Scheinbaum ML. Antipyretic efficacy of ibuprofen vs
acetaminophen. Am J Dis Child 1992;146:622-625.
5. Khubchandani RP, Ghatikar KN, Keny S et al. Choice of antipyretic in children. J
Assoc Physicians India 1995;43:614-16.
6. McIntyre J, Hull D. Comparing efficacy and tolerability of ibuprofen and
paracetamol in fever. Arch Dis Child 1996;74:164-7.
7. Autret E, Reboul-Marty J, Henry-Launois B et al. Evaluation of ibuprofen versus
aspirin and paracetamol on efficacy and comfort in children with fever. Eur J
Clin Pharm 1997;51:367-1.
8. Vauzelle-Kervroedan F, d'Athis P, Pariente-Khayat A et al. Equivalent antipyretic
activity of ibuprofen and paracetamol in febrile children. J Pediatr 1997;131:683-
7.
9. Wong A, Sibbald A, Ferrero F et al. Antipyretic effects of dipyrone versus
ibuprofen versus acetaminophen in children: results of a multinational,
randomized, modifiable double-blind study. Clin Pediatr (Phila). 2001;40:313-
24.
10. Figueras NC, Garcia de Miguel MJ, Gomez CA et al. Effectiveness and
tolerability of ibuprofen-arginine versus paracetamol in children with fever of
likely infectious origin. Acta Paediatr. 2002;91:383-90.