The safety of ibuprofen suspension in children

Area of Science:

• Pediatrics
• Pharmacology
• Infectious Diseases

Background:

• Fever is a common symptom in children, often treated with antipyretic medications like ibuprofen and paracetamol.
• Concerns exist regarding the safety of these medications, particularly the risk of serious adverse events and associations with infections.

Purpose of the Study:

• To compare the safety of ibuprofen and paracetamol in febrile children.
• To assess the risk of rare but serious adverse events associated with these antipyretics.
• To investigate the association between antipyretic use, varicella infection, and necrotizing fasciitis.

Main Methods:

• The Boston University Fever Study: A large observational study involving 84,192 children to assess adverse events.
• Case-control study: Investigated 52 children with varicella and Group A streptococcal infection against 172 controls with uncomplicated varicella.

Main Results:

• No significant differences in admission risk or secondary endpoints (asthma, cellulitis, abdominal pain, dyspepsia) between ibuprofen and paracetamol.
• Ibuprofen was associated with a significantly lower risk of physician visits for asthma (3.0% vs. 5.1%, P = 0.02).
• No association between single-agent antipyretic use and invasive Group A streptococcal infection; however, concurrent use of ibuprofen and paracetamol was significantly associated.

Conclusions:

• Children with fever tolerate ibuprofen as well as paracetamol.
• Neither ibuprofen nor paracetamol, when used alone, is associated with an increased risk of necrotizing soft tissue infections.
• Concurrent use of ibuprofen and paracetamol may be associated with an increased risk of invasive Group A streptococcal infection in children with varicella.