Ibuprofen In Children Research Articles

Glutathione and arginine levels: Predictors for acetaminophen-associated asthma exacerbation?

Glutathione and arginine levels: Predictors for acetaminophen-associated asthma exacerbation?

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal.

Ibuprofen is the most widely used non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild-to-moderate pain and fever in children, and is the only NSAID approved for use in children aged ≥3 months. Its efficacy and safety profile have led to its increasing use in paediatric care, even without medical prescription. However, an increase of suspected adverse reactions to ibuprofen has been noted in concomitance with the raised, often medically unsupervised, consumption of the drug. The purpose of this work was a critical review of the paediatric literature over the last 15 years on side effects and adverse events associated with ibuprofen, in order to highlight circumstances associated with higher risks and to promote safe and appropriate use of this drug. The literature from 2000 to date demonstrates that gastrointestinal events are rare, but (when they occur) include both upper and lower digestive tract lesions. Dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with diarrhoea and vomiting, with or without fever. Likewise, ibuprofen should never be administered to patients who are sensitive to it or to other NSAIDs. It is contraindicated in neonates and in children with wheezing and persistent asthma and/or during varicella. Most of the analysed studies reported adverse events when ibuprofen was being used for fever symptoms or flu-like syndrome. Ibuprofen should not be used as an antipyretic, except in rare cases. Ibuprofen remains the drug of first choice in the treatment of inflammatory pain in children.

Acetaminophen and asthma-related complications in children (acetaminophen vs. ibuprofen in children with asthma trial): A summary

Acetaminophen and asthma-related complications in children (acetaminophen vs. ibuprofen in children with asthma trial): A summary

Does the Use of Ibuprofen in Children with Extremity Fractures Increase their Risk for Bone Healing Complications?

BackgroundDespite being an effective analgesic for children with fractures, some clinicians may avoid prescribing ibuprofen due to its potentially harmful effect on bone healing. ObjectiveTo determine if exposure to ibuprofen is associated with an increased risk of bone healing complications in children with fractures. MethodsWe performed a retrospective study of children aged 6 months to 17 years who presented to the pediatric emergency department (PED) with a fracture of the tibia, femur, humerus, scaphoid, or fifth metatarsus and who followed up with the orthopedic service. We chose these fractures due to their higher risk for complications. We classified patients as exposed if they received ibuprofen in the PED or during hospitalization or were prescribed ibuprofen at discharge. The main outcome was a bone healing complication as evidenced by nonunion, delayed union, or re-displacement on follow-up radiographs. ResultsOf the 808 patients included in the final analysis, 338 (42%) were exposed to ibuprofen. Overall, 27 (3%) patients had a bone healing complication; 8 (1%) developed nonunion, 3 (0.4%) developed delayed union, and 16 (2%) developed re-displacement. Ten (3%) patients who were exposed to ibuprofen, and 17 (4%) who were not, developed a bone healing complication (odds ratio 0.8, 95% confidence interval 0.4–1.8; p = 0.61). There was no significant association between ibuprofen exposure and the development of a bone healing complication despite adjustment for potential confounders. ConclusionChildren with extremity fractures who are exposed to ibuprofen do not seem to be at increased risk for clinically important bone healing complications.

Effects of Acetaminophen and Ibuprofen in Children With Migraine Receiving Preventive Treatment With Magnesium

The purpose of this study was to evaluate both the effects of ibuprofen and/or acetaminophen for the acute treatment of primary migraine in children in or out prophylactic treatment with magnesium. Children ranging from the ages of 5 to 16 years with at least 4 attack/month of primary migraine were eligible for participation the study. A visual analog scale was used to evaluate pain intensity at the moment of admission to the study (start of the study) and every month up to 18 months later (end of the study). One hundred sixty children of both sexes aged 5-16 years were enrolled and assigned in 4 groups to receive a treatment with acetaminophen or ibuprofen without or with magnesium. Migraine pain endurance and monthly frequency were similar in the 4 groups. Both acetaminophen and ibuprofen induced a significant decrease in pain intensity (P < .01), without a time-dependent correlation, but did not modify its frequency. Magnesium pretreatment induced a significant decrease in pain intensity (P < .01) without a time-dependent correlation in both acetaminophen- and ibuprofen-treated children and also significantly reduced (P < .01) the pain relief timing during acetaminophen but not during ibuprofen treatment (P < .01). In both acetaminophen and ibuprofen groups, magnesium pretreatment significantly reduced the pain frequency (P < .01). Magnesium increased the efficacy of ibuprofen and acetaminophen with not age-related effects.

Paracetamol plus ibuprofen increased time without fever compared with paracetamol but did not differ from ibuprofen in children

A D Hay Dr A D Hay, University of Bristol, Bristol, UK; alastair.hay@bristol.ac.uk How does paracetamol (PCM) plus ibuprofen (IBF) compare with either drug alone for treating fever in children?...

The effects and safety of dexibuprofen compared with ibuprofen in febrile children caused by upper respiratory tract infection

To evaluate the antipyretic efficacy and tolerability of dexibuprofen compared with ibuprofen in children with fever caused by upper respiratory tract infection (URTI). The study population consisted of children aged 6 months to 14 years. At the time of visit to the hospital, the children had fever; the cause of fever was determined to be URTI by a paediatrician based on history taking and physical examination. The study was a multicentre, randomized, double-blind, controlled parallel group, comparative, Phase 3 clinical trial, conducted at three hospitals. By using a computer-based random assignment program, the subjects were allocated to the following three groups: 5 mg kg(-1) dexibuprofen group, 7 mg kg(-1) dexibuprofen group, and 10 mg kg(-1) ibuprofen group. In the clinical trial of the antipyretic action of dexibuprofen in patients with fever caused by URTI, there was no statistically significant difference in maximal decrease of temperature and mean time to become apyrexial among the 5 mg kg(-1) dexibuprofen, 7 mg kg(-1) dexibuprofen and 10 mg kg(-1) ibuprofen groups (P > 0.05). There also was no significant difference in adverse drug reaction (P > 0.05). Dexibuprofen is as effective and tolerable as ibuprofen. A dose of 5 mg kg(-1) and 7 mg kg(-1) dexibuprofen in place of 10 mg kg(-1) ibuprofen would be sufficient to control fever caused by URTI in children.

Cerebrospinal Fluid Distribution of Ibuprofen After Intravenous Administration in Children

Ibuprofen is the most commonly used nonsteroidal, antipyretic, antiinflammatory analgesic in children. Nonsteroidal, antipyretic, antiinflammatory analgesics act in both the peripheral tissues and the central nervous system. The central nervous system penetration of ibuprofen has been described in adults but not in children. Our goals were to investigate the cerebrospinal fluid penetration of ibuprofen in children and evaluate the analgesic plasma concentration of ibuprofen after inguinal surgery in children. A total 36 healthy children (25 boys) aged 3 months to 12 years received a single intravenous injection of ibuprofen (10 mg/kg). A paired cerebrospinal fluid and blood sample was obtained 10 minutes to 8 hours after the injection. In children having inguinal surgery, a second blood sample was obtained at the time that the child first had wound pain. The ibuprofen level was determined in all cerebrospinal fluid and plasma samples. Cerebrospinal fluid concentrations ranged between 15 and 541 microg/L, and the highest concentrations were measured 30 to 38 minutes after dosing. In all cerebrospinal fluid samples collected after 30 minutes, ibuprofen concentration exceeded that of unbound plasma. The plasma analgesic concentrations after inguinal surgery ranged between 10 and 25 mg/L. Ibuprofen penetrates the cerebrospinal fluid readily, with peak concentrations attained 30 to 40 minutes after intravenous injection of a 10 mg/kg dose. The plasma analgesic concentration after inguinal surgery with spinal anesthesia is 10 to 25 mg/L.

Gastrointestinal Bleeding in Children Following Ingestion of Low‐dose Ibuprofen

Gastrointestinal Bleeding in Children Following Ingestion of Low‐dose Ibuprofen

Quel niveau de preuve de l'efficacité et de la sécurité de l'ibuprofène dans ses indications pédiatriques ?

Ibuprofen is the non-steroidal anti-inflammatory drug most prescribed for the treatment of fever and moderate pain in childhood. Its analgesic and antipyretic efficacy is now well documented: at equal doses ibuprofen appears slightly more effective than acetaminophen in the treatment of fever and is equivalent for analgesia. However, adverse effects should be taken into account in the choice between ibuprofen and acetaminophen. Lot of studies (case reports, cohort studies, case-control studies and one multicenter double-blind randomized control trial) have reported ibuprofen adverse effects at therapeutics doses. These data suggest there is an increased risk of invasive group A streptococcal infection after chickenpox and of acute renal failure in case of hypovolemia after a treatment by ibuprofen. Gastroduodenal and hemorrhagic adverse events could also happen, but the causality with ibuprofen is not demonstrated. Therefore, ibuprofen is not recommended for the treatment of fever or moderate pain during chickenpox or during a disease with a risk of dehydration, until other pharmacoepidemiology studies more accurately quantify the risk of adverse events of ibuprofen in children.

Study Comparative of the Effect Against the Fever of the Acetaminophen vs Ibuprofen in Children of 6 Months to 6 Years Old: P089

Objective: To compare the effectiveness of the ibuprofen and acetaminophen in children with fever.Subjects and Methods: Design: An experimental study (controlled, randomized, double blind) was performed, with design of clinical test. Subjects: Febrile children from 4 months to 10 years of age, receiving medical care in a emergency service. Interventions: At random each boy was assigned to receive a single dose of acetaminophen (15mg/kg), ibuprofen (10mg/kg) or placebo (5 ml/kg).Results: 197 patients were included in the study, 64 were administered with acetaminophen, 67 ibuprofen and 66 placebo. The temperature was measured at the moment the patient‘s arrival; then it was measured 10, 20 and 30 minutes and 1, 2, 3, 4, 5 and 6 hours later. It was managed to decrease the temperature below 38°C in 55 patients receiving acetaminophen, in 56 patients receiving ibuprofen and in 32 patients receiving placebo. The comparison between each of them was made to value the effectiveness. Between acetaminofen and ibuprofeno was obtained x2 = 0.14, p = 0.70; between acetaminofen and placebo x2 = 20.43; p = 0.000006; between ibuprofeno and placebo X2=18.16, p = 0.00004.Conclusions: The antipyretic effectiveness of acetaminophen and ibuprofen is significantly greater than placebo. Between acetaminophen and ibuprofen, we did not observe statistically significant differences.

Additional to caudal bupivacaine preemptive oral ibuprofen does not improve postoperative pain, nausea or vomiting, and resumption of normal activities in children after ambulatory pediatric urologic surgery

Objectives To investigate the possible advantage of administration of preemptive oral ibuprofen in children after ambulatory pediatric urologic surgery such as penile surgery (circumcision and hypospadias repair) and inguinal surgery (communicating hydrocele and orchidopexy), a study was performed on the experience of postoperative pain, nausea or vomiting, and resumption of normal activities such as normal sleep and play activity. In addition, this study has validated a method of measurement of pain and resumption of normal activities in children. Material and methods In a prospective, randomized, double-blind study, 66 prepubertal boys (0–12 years) underwent an ambulatory pediatric urological intervention. One hour prior to surgery, the experimental group received 10 mg/kg oral ibuprofen along with their usual premedication (<8 years midazolam 0.5 mg/kg PO or rectal; >8 years or >30 kg alprazolam 0.5 mg, 0.25–0.5 mg PO), whereas the children of the control group received only the usual premedication. Anesthesia was achieved with Sevorane ® (Sevoflurane) inhalation induction (Sevoflurane 8% in 50% N 2O/50% O 2) and a locoregional caudal block (0.5–1.0 ml/kg levobupivacaine 0.25% with a maximum of 30 ml). Immediate postoperative pain was assessed by the child, the parents and a single observer using the Faces Pain Scale and the CHEOPS behavioral scale (Children's Hospital of Eastern Ontario Pain Scale). Vomiting and nausea were also assessed. On the first and second postoperative day the same variables were evaluated by the child and the parents, as well as quality of sleep and play, and need for pain medication. Results No difference in the experience of pain was found at any point after the operation between the experimental and control groups; moreover, the consumption of pain medication postoperatively did not differ between the two groups. There was also no difference in the incidence of vomiting and nausea in the hospital or at home ( p>0.05). The method for measuring pain and normal activities was validated as the assessments of the parents, children and the investigators were concordant throughout the study. Conclusions Children who received preoperative oral ibuprofen (10 mg/kg) did not experience less pain or less nausea and vomiting, and did not show a better pattern of sleep and play up to 2 days after ambulatory pediatric urologic surgery than children who did not receive this medication.

Influence of preoperative oral ibuprofen on postoperative pain and normal activities in children after ambulatory genito-urinary surgery

Introduction: To investigate the possible advantage of administration of preoperative oral ibuprofen in children on the experience of postoperative pain and resumption of normal activities such as normal sleep and play activity. Material and methods: A prospective, randomized, double blind study in 54 children (0–14 years) who underwent an ambulatory urological operation was performed. The children of the experimental group received 1 h prior to surgery, 10 mg/kg oral ibuprofen together with their usual premedication, whereas the children of the control group received only the usual premedication. Anesthesia was conducted with sevoflurane inhalation and either a locoregional caudal block (children <30 kg) or local analgesia (children >30 kg). Immediate postoperative pain was assessed using the Faces Pain Scale and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS behavioral scale). Vomiting and nausea were also assessed. On the first and second postoperative day, the same variables were evaluated, as well as quality of sleep, play and need for pain medication. Results: After performing subanalysis, it was the older children (10–14 year) from the experimental group who experienced more pain. No significant differences were found regarding vomiting and nausea in the hospital or at home ( P > 0.05). The assessments of the parents, children as well as the investigators’ were concordant throughout the study. Conclusions: Older children (10–14 years) who underwent ambulatory genito-urinary surgery under local anesthesia with sedation required more analgesia than was provided by this regimen. The older children who received preoperative oral ibuprofen (10 mg/kg) demonstrated significantly more pain early postoperative and on the first day at home. This study did not show a difference in postoperative pain, nausea and vomiting, or sleep and play quality up to 2 days after surgery that could be attributed to preoperative oral ibuprofen; however, the number of patients studied may have been too few to detect a difference. The children's and parents’ assessments of pain using the face scale and the investigators’ assessments using the CHEOPS scale were comparable.

Ibuprofen and increased morbidity in children with asthma: fact or fiction?

NSAIDs are commonly avoided by patients with aspirin-induced asthma based on the premise that there is a significant cross-reactivity between aspirin and other NSAIDs. However, ibuprofen, a NSAID sold over the counter in most countries, is commonly given to children for relief of fever and mild-to-moderate pain. Consequently, increased risk of acute bronchospasm induced by ibuprofen in children with asthma remains a persistent concern. More recently, the assumption that children with asthma are at a greater risk for exacerbations of their disease if they take ibuprofen has been questioned. There is little evidence to measurably increases morbidity in the great majority of children with asthma. In addition, recent evidence suggest that ibuprofen measurably increases morbidity in the great majority of [corrected] children with asthma. Given the infrequent occurrence of aspirin/NSAID sensitivity in children with asthma, it seems reasonable to allow the use of ibuprofen in this population unless there is a personal or family history of aspirin-induced asthma. In addition, the inflammatory pathogenesis of asthma, anti-inflammatory effect of ibuprofen, and evidence suggesting ibuprofen may reduce morbidity in children with asthma raises the intriguing possibility that ibuprofen might actually have therapeutic benefit for at least some children with asthma.

Pharmacokinetics of Ibuprofen in children with cystic fibrosis.

An exaggerated inflammatory response is responsible for the decline of lung function in patients with cystic fibrosis (CF). Ibuprofen is a potent anti-inflammatory agent that demonstrates inhibition of neutrophil activity in vitro at concentrations between 50 and 100 mg/L, whereas lower concentrations result in an increase in inflammatory mediators. Significant decline in the rate of deterioration of pulmonary function and increased nutritional status were observed in children with CF who were administered long-term high-dosage ibuprofen therapy. As with many other drugs, CF patients appear to exhibit altered pharmacokinetics of ibuprofen (reduced bioavailability, increased volume of distribution, and more rapid clearance) when compared with healthy controls. However, the absence of studies with intravenous ibuprofen as well as protein binding measurements in patients with CF currently limits the ability to compare the pharmacokinetics with those in other populations. Current studies indicate that there is high interpatient variability in ibuprofen pharmacokinetics among CF patients. Some of this variability can be explained by differences in ibuprofen formulation administered. Therapeutic drug monitoring of high-dosage ibuprofen therapy is recommended because of the biphasic response to inflammatory mediators demonstrated in vitro as well as the high interpatient variability in pharmacokinetics. Due to the differences in absorption characteristics between ibuprofen formulations, the timing of obtaining blood samples for pharmacokinetic analysis is critical. Maximum a posteriori Bayesian analysis has been shown to provide more accurate and precise estimates of the pharmacokinetic parameters of ibuprofen in children with CF, and may also be a useful tool to further investigate the relationship between measures of drug exposure and efficacy/toxicity outcomes.

Antipyretics Do Not Prevent Febrile Convulsions

Neurology| October 01 2003 Antipyretics Do Not Prevent Febrile Convulsions AAP Grand Rounds (2003) 10 (4): 42–43. https://doi.org/10.1542/gr.10-4-42 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Antipyretics Do Not Prevent Febrile Convulsions. AAP Grand Rounds October 2003; 10 (4): 42–43. https://doi.org/10.1542/gr.10-4-42 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: antipyretic therapy, febrile seizures Source: El-Radhi AS, Barry W. Do antipyretics prevent febrile convulsions? Arch Dis Child. 2003;88:641–642. Whether antipyretic medications prevent febrile seizures (FS) in at-risk children was investigated by pediatricians at Queen Mary’s Hospital, Sidcup, Kent, United Kingdom, using a literature search technique. Four previously published controlled studies were reviewed. One randomized, placebo-controlled trial found paracetamol (acetaminophen), with or without diazepam, to be ineffective in the prevention of FS during subsequent fevers. A second randomized trial comparing the antipyretic effectiveness of paracetamol administered at regular intervals (group 1) versus only at the time of fever (group 2) in children presenting with a FS found that early recurrences of FS (within the first 24 hours) were similar in the 2 groups. A third randomized, double-blind, controlled study using ibuprofen in children at risk of FS found similar recurrence rates in antipyretic- and placebo-treated patients. In a fourth study, an open trial, the risk of FS recurrence was similar in at-risk patients offered either ibuprofen or paracetamol at times of fever. It was concluded that the results of these 4 studies and the findings in a recently published review of 12 randomized controlled trials of paracetamol1 show no convincing evidence that antipyretics prevent FS. The prescription of paracetamol in a child at risk of FS may be expected to provide symptomatic relief but should not be recommended for the prevention of FS. The height of the body temperature when a seizure occurs is a measure of the febrile seizure threshold and an important determinant of the induction of FS.2 Risk factors for recurrence of FS include a low febrile seizure threshold (low grade fever at onset of FS), complex FS, age less than 1 year, and family history of FS. Animal studies support the conclusions regarding the ineffectiveness of antipyretic agents in the prevention of FS. Acetaminophen fails to retard the rate of temperature rise induced by radiotherm diathermy in animals, and large toxic doses of aspirin lower the threshold convulsive temperature and exacerbate experimental FS.2 Antipyretics, in therapeutic doses, facilitate heat loss by increased peripheral blood flow and sweating3 and, thereby, relieve discomfort associated with fever but do not retard temperature rise and have no proven anticonvulsant effect. Heat production is not inhibited by salicylates, but heat dissipation is augmented. Numerous studies have shown comparable antipyretic efficacy for aspirin and acetaminophen (APAP) in febrile children.4 Maximum antipyresis for rectal suppositories of APAP occurs at 2.5 to 4 hours, and efficacy of both oral and rectal APAP is related to dose and plasma level. Addition of tepid water sponging increases maximum antipyresis of APAP, but does not shorten time of onset of antipyresis. Ineffectiveness of intermittent antipyretic treatment in the prevention of FS is sometimes linked to failure to determine plasma levels, poor compliance, and difficulty in recognizing the onset of the febrile illness. Ibuprofen was superior to APAP in antipyretic efficacy in a randomized, multiple dose, double-blind study comparing ibuprofen (5 mg/kg) and... You do not currently have access to this content.

Ibuprofen was more protective against asthma morbidity than acetaminophen in asthmatic children with fever

(2002) Pediatrics 109, e20; Lesko SM, Louik C, Vezina RM, Mitchell AA. . Asthma morbidity after the short-term use of ibuprofen in children. . Feb; . : . . ....

Pharmacokinetics of Ibuprofen Enantiomers in Children with Cystic Fibrosis

Chiral inversion of R(-)- to S(+)-ibuprofen in children with cystic fibrosis was investigated. Children with cystic fibrosis (n = 38, ages 2-13 years) were administered a single oral dose of racemic ibuprofen (20 mg/kg), and the pharmacokinetics of ibuprofen was found to be stereoselective. Mean Cmax, AUC, apparent CL/F, and Varea/F of S-ibuprofen were significantly different from those of R-ibuprofen. The enantiomeric ratio of plasma AUC (S:R = 2.09:1) and of free and conjugated ibuprofen in urine (S:R = 13.9:1) of children with cystic fibrosis was not different from reported values for healthy children and adults. No significant gender difference was observed for any of the pharmacokinetic parameters determined. However, there was an inverse linear relationship between the CL/F of R-ibuprofen and age in children with cystic fibrosis. Apparent CL/F was higher in children with cystic fibrosis than previously reported for healthy children; therefore, higher doses of ibuprofen would be necessary for children with cystic fibrosis.

Chiral inversion of ibuprofen in children with cystic fibrosis*

Chiral inversion of ibuprofen in children with cystic fibrosis*

Reevaluation of antipyretics in children with enteric fever

The Committee on Infectious Diseases of the American Academy of Pediatrics recommends withholding antipyretic administration to patients with enteric fever because of the risk of shock developing as a consequence. To evaluate the effects of antipyretics on blood pressure in children with enteric fever. A retrospective review of medical records of patients admitted to Texas Children's Hospital from January, 1977, to October, 1997, with a diagnosis of enteric fever. All febrile episodes were evaluated for the use of antipyretics and evidence of hypotension or cardiovascular decompensation associated with them. Twenty-nine patients with enteric fever were identified. Salmonella typhi caused 23 of these infections. Antipyretics were used in all but one patient. We did not find any association between the use of antipyretics and the development of hypotension. One patient developed shock and adult respiratory distress syndrome >36 h after start of antibiotic therapy and unrelated to fever or antipyretic use. Two patients had evidence of dehydration. No other complications occurred. We did not find any complications associated with the use of acetaminophen or ibuprofen in children with enteric fever. The effects of antipyretics in enteric fever should be further studied.