ANTIPYRETIC EFFICACY OF IBUPROFEN AND ACETAMINOPHEN IN CHILDREN WITH FEBRILE SEIZURES

Objective: To compare the antipyretic efficacy of ibuprofen syrup (5 m g/kg per dose) and acetaminophen syrup (10 mg/kg per dose) in children with a history of febrile seizures. Design: Randomized, multiple-dose , double-blind, crossover trial. Setting: The outpatient department of a university-affiliated teaching hospital. Patients: Seventy outpatie nts (mean age, 2.1 years; range, 10 months to 4 years) who had visited the hospital because of a febrile seizure were randomized to treatmen t at a temperature of 38.5 degrees C or higher. Interventions: Study m edication was given every 6 hours for 1 to 3 days. Rectal temperatures were recorded at 0, 2, 4, 6, 12, and 24 hours after the first dose. M ain Outcome Measures: The temperature 4 hours after the first dose, th e mean temperature during treatment, and the highest temperature durin g treatment were evaluated. Analysis of covariance corrected for the i nitial temperature, age, weight, and cause of the fever. Results: Ibup rofen lowered the initial temperature from 39.1 degrees C to a mean te mperature of 37.7 degrees C during treatment; acetaminophen lowered th e initial temperature from 39.2 degrees C to 38.0 degrees C. Ibuprofen reduced fever 0.50 degrees C more than did acetaminophen at 4 hours ( 95% confidence interral [CI], -0.98 to -0.02). The mean temperature wa s 0.26 degrees C lower during ibuprofen treatment (95% CI, -0.59 to 0. 07); the highest temperature was 0.30 degrees C lower (95% CI, -0.73 t o 0.13). In 22 patients, a second fever was treated with the opposite medication than the first. In the crossover analysis, the respective d ifferences were 0.66 degrees C (95% CI, -1.29 to -0.06), 0.40 degrees C (95% CI, -0.83 to 0.03), and 0.36 degrees C (95% CI, -0.81 to 0.08) in favor of ibuprofen. Conclusions: Ibuprofen and acetaminophen are ef fective antipyretic agents in children with a history of febrile seizu res. Ibuprofen yielded significantly greater fever reduction than did acetaminophen 4 hours after the first dose. Research is needed on the value of antipyretic agents for the prevention of febrile seizure recu rrence.