Commentary

Because of its analgesic properties and lack of gastrointestinal side effects, paracetamol has long been seen as a relatively safe medication for the relief of fever and mild to moderate pain in children. Recently, however, ibuprofen has emerged as an alternative. With choice, questions invariably arise as to which drug is superior. Existing findings on the effectiveness and safety of these drugs in adults cannot be generalised to children. Thus, the meta-analysis by Perrott et al is of particular interest. The authors searched for relevant studies using numerous data sources, included only studies with randomised blinded designs, and verified the reliability of independently coded outcome measures with appropriate statistics. The authors stated that no unpublished studies were identified by hand searches, contact with pharmaceutical companies, or a posting on an international listserv. Nonetheless, the possibility exists that a publication bias of unknown size and direction may be operating.

Perrott et al did not find evidence that paracetamol and ibuprofen differ for short term pain relief or safety, but they did find that ibuprofen is more effective than paracetamol for treating fever. It is important to consider these results in the larger context of management of short term fever in children. Prolonged use of antipyretics to lower temperature has been known to mask symptoms of serious infection and cause liver damage and death in dehydrated children.¹ Some evidence suggests that non-pharmacological interventions, such as minimal clothing and extra drinks, may help to reduce fever in children, although sponging does not seem to have a long term effect.¹ Fever is often the body’s normal response to infection, and simple non-pharmacological strategies may be all that is needed to reduce a fever. Nurses have a role in educating parents about the physiological basis of fever and the contribution of non-pharmacological interventions. Further research should focus on direct comparisons of various non-pharmacological interventions with antipyretic medications as well as the relative effectiveness of these drugs under usual multiple dosing situations, and their use in combination. Questions about safety will require large scale observational studies because adverse effects are rare.