A5V4d

Feverish illness in children
Review question
The clinical question outlined in the scope and examined in the review was “Whether reducing fever
with paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) affects the course of the
disease?”
Description of included studies
Seven studies were included in the review (Sugimura et al., 1994; Byington et al., 2002; Francois et
al., 2010; Mikaeloff et al., 2007; Dubos et al., 2008; Lesko et al., 2001; Doran et al., 1988). One study
was an RCT (Doran et al., 1988), four were prospective observational studies and two were
retrospective observational studies.
Four studies examined the effect of antipyretics on outcomes in children with chickenpox (Mikaeloff et
al., 2007; Dubos et al., 2008; Lesko et al., 2001; Doran et al., 1988) and three examined the effect on
pneumonia (Sugimura et al., 1994; Byington et al., 2002; Francois et al., 2010). Sample sizes range
from 156,034 in the retrospective study to 72 in the RCT.
For this review, post-vaccination fever was not counted as an illness.
Evidence statements
The GRADE profiles presented show results of included studies for the review question.
Table 9.1 GRADE findings for outcome of disease in children after antipyretics
Number of
studies
194
Number of children Effect Quality
Antipyretic No
treatment
Relative
(95% confidence interval)
Cases of complicated pneumonia vs. uncomplicated pneumonia using ibuprofen
1 (Byington
et al.,
2002)
1 (Francois
et al.,
2010)
Ibuprofen No
treatment
Ibuprofen No
treatment
Adjusted OR 4.0 (2.5 to 6.5),
P < 0.001 a
Adjusted OR 2.57 (1.51 to 4.35),
P < 0.001 a
Primary varicella with skin or soft tissue complications using paracetamol
1 (Mikaeloff
et al.,
2007)
1 (Mikaeloff
et al.,
2007)
1 (Dubos et
al., 2008)
Paracetamol No
treatment
Paracetamol No
treatment
Paracetamol No
treatment
Adjusted RR 4.9 (2.1 to 11.4) a
Adjusted RR 1.5 (1.0 to 2.2) a
Adjusted OR 4.8 (1.6 to 14.4),
P = 0.005 a
Absolute
(95% confidence
interval)
Risk of any invasive group A streptococcal infection using ibuprofen or paracetamol
1 (Lesko et
al., 2001)
1 (Lesko et
al., 2001)
Any
ibuprofen
during
illness
Any
acetaminoph
en during
illness
No
ibuprofen
No
acetamino
phen
OR 3.9 (1.3 to 12) a
OR 1.2 (0.50 to 3.0) a
- Very
low
- Very
low
- Very
low
- Very
low
- Very
low
- Very
low
- Very
low
2013 Update