Treatment of pediatric fever: Are acetaminophen and ibuprofen equivalent?

Evidence A meta-analysis and recent randomized controlled trial provide some guidance. • Meta-analysis of 10 trials (N = 1078) of ibuprofen (5 to 10 mg/kg) versus acetaminophen (10 to 15 mg/kg)1: -ibuprofen was superior at 2, 4, and 6 hours; and -at 4 to 6 hours, approximately 15% more ibuprofen patients had fever reduction (number needed to treat = 7). • PITCH randomized controlled trial (N = 156, aged 6 months to 6 years) comparing ibuprofen (10 mg/kg every 6 to 8 hours), acetaminophen (15 mg/kg every 4 to 6 hours), or a combination of both2: -For time without fever in the first 4 hours, the combination was superior to acetaminophen by 55.3 minutes (P < .001) but was not superior to ibuprofen. -Ibuprofen and the combination cleared fever faster. -The combination reduced fever time in the first 24 hours (acetaminophen 4.4 hours more [P < .001], ibuprofen 2.5 hours more [P = .008]). -Overdose was reported in 33 children (21%). -The authors recommended ibuprofen: —ibuprofen was superior to acetaminophen; —the combination was only slightly better on a few outcomes than ibuprofen alone; and —there was a possible risk of excess dosing with the combination.