Comparison of Acetaminophen (Paracetamol) With Ibuprofen for
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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. A Study was conducted 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. Data were pooled using a fixed-effects method if I2 was less than 50% and using a random-effects method if I2 was 50% or greater.

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.

Results:
Overall, 19 studies (11 randomized; 8 nonrandomized) of 241138 participants from 7 countries and various health care settings 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; I2 = 49%; moderate quality evidence) and
--at 4 to 24 hours (5 studies with 879 participants; SMD, 0.24; I2 = 57%; moderate-quality evidence) and less pain at 4 to 24 hours (2 studies with 535 participants; SMD, 0.20; I2 = 25%; moderate-quality evidence). Adverse events were uncommon.
--Acetaminophen and ibuprofen appeared to have similar serious adverse event profiles (7 studies with 27932 participants; ibuprofen vs aceteminophen: odds ratio, 1.08; moderate-quality evidence).

In this study, use of ibuprofen vs acetaminophen for the treatment of fever or pain in children younger than 2 years was associated with reduced temperature and less pain within the first 24 hours of treatment, with equivalent safety.

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772373
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