Acetaminophen vs. ibuprofen: Does meta-analysis point the way?

Investigators performed a meta-analysis of 17 randomized controlled trials to compare the safety and relative efficacy of acetaminophen and ibuprofen for treating pain and fever. The analyzed studies, published between 1985 and 2002, typically were single-dose, randomized, double-blinded trials of 10 mg/kg of each drug used to treat fever or moderate or severe pain in participants younger than 18 years. Of the 17 studies, three provided data for pain relief analysis, 10 for fever reduction, and all 17 for safety.

A single dose of ibuprofen (4 to 10 mg/kg of body weight) and a single dose of acetaminophen (7 to 15 mg/kg) were found equally effective for relieving moderate or severe pain. However, single doses of ibuprofen (4 to 10 mg/kg) were better than acetaminophen (7 to 15 mg/kg) at reducing temperature two, four, and six hours after treatment, especially when the ibuprofen dose was 10 mg/kg. Last, the meta-analysis did not reveal any differences between the two drugs and placebo with regard to safety (Perrott DA et al: Arch Pediatr Adolesc Med 2004;158:521).

Commentary: Before changing practice based on this meta-analysis, read the accompanying editorial by Peter Cummings, MD. He questions the validity of using standard effects in meta-analysis, a statistical technique employed in this study.

This concern aside, if we really believe that treatment of fever is unnecessary, the more important issue is relief of pain. The three studies in the meta-analysis that addressed pain (comprising 185 patients) yielded relevant data showing that the two agents do not differ in their ability to relieve pain.

DR. BURKE, section editor for Journal Club, is chairman of the department of pediatrics at Saint Agnes Hospital, Baltimore. He is a contributing editor for Contemporary Pediatrics.