Treating fever in children: paracetamol or ibuprofen?

Community health practitioners frequently prescribe or advise parents on antipyretic medications for children with fevers. This mini-review sets out to examine the evidence for the relative effectiveness of two of the most widely available and commonly used over-the-counter medicines - paracetamol and ibuprofen. A systematic literature search was undertaken to identify all studies comparing the effects of the two drugs. The Medline, Embase, Cinahl and RCN databases were searched. Eight randomized controlled trials that reported temperature differences at time-points between 1 and 6 hours after administration were identified. Statistical meta-analysis showed no clear benefit for one drug over another 1 hour after administration. However, by 6 hours after administration ibuprofen was clearly superior resulting in a mean temperature 0.58 degrees C lower than paracetamol. Both drugs appeared well tolerated and no evidence of difference in short-term adverse effects was observed. Both drugs are effective antipyretics but the longer action of ibuprofen may make it preferable in some circumstances.