A5V4d
A5V4d
A5V4d
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Feverish illness in children<br />
Evidence statements<br />
A number of calculations have been used in this review. For a relative risk an effect size of 0.25 with<br />
the 95% confidence interval not crossing 1 (no effect) was considered a large effect. For standardised<br />
mean differences an effect size of 0.1 was considered small, 0.3 medium and 0.5 large.<br />
Paracetamol compared with placebo<br />
One RCT found that quality of life (comfort, activity, alertness, mood and appetite) was improved in<br />
children who received paracetamol compared with children who received placebo to treat fever. This<br />
finding was a moderate effect size and was statistically significant. The evidence for this finding was<br />
of low quality.<br />
Four RCTs found that temperature was reduced more in children who received paracetamol<br />
compared with children who received placebo to treat fever. This finding was statistically significant in<br />
all the studies. The evidence for this finding ranged from high to very low quality.<br />
A meta-analysis of seven RCTs found more adverse events reported in children who received<br />
paracetamol compared with children who received placebo to treat fever. This finding was not<br />
statistically significant. The evidence for this finding was of very low quality.<br />
One observational study found that rates of asthma, eczema and rhinoconjunctivitis were higher in<br />
children who had used paracetamol in the first year of life or within the past 12 months compared with<br />
those who had not. This finding was statistically significant, but these kinds of studies are unable to<br />
demonstrate a causal relationship between paracetamol use and long-term conditions. The evidence<br />
for this finding was very low quality.<br />
Ibuprofen compared with placebo<br />
No data was found on quality of life.<br />
Three RCTs found that temperature was reduced more in children who received ibuprofen compared<br />
with children who received placebo to treat fever. This was a large effect and the finding was<br />
statistically significant. The evidence for this finding ranged from moderate to low in quality.<br />
A meta-analysis of seven RCTs found more adverse events reported in children who received<br />
ibuprofen compared with children who received placebo to treat fever. This finding was statistically<br />
significant. The evidence for this finding was of low quality.<br />
Paracetamol compared with ibuprofen<br />
Two RCTs found that quality of life was improved in children who received ibuprofen compared with<br />
children who received paracetamol to treat fever up until 6 hours after treatment, but not thereafter.<br />
This finding was a moderate effect size and was statistically significant. The evidence for this finding<br />
was of low quality.<br />
One RCT found that there was no difference in quality of life in children who received ibuprofen<br />
compared with children who received paracetamol to treat fever from day 1 to 3 of treatment. This<br />
finding was statistically significant. The evidence for this finding was of low quality.<br />
Ten RCTs found either no difference or moderate differences in favour of ibuprofen in temperature<br />
reduction between 1 and 6 hours after treatment began in children who received ibuprofen compared<br />
with children who received paracetamol to treat fever. The evidence for this finding ranged from high<br />
to very low in quality.<br />
Three RCTs found that the proportion of afebrile patients was higher in the group of children who<br />
received ibuprofen compared with children who received paracetamol to treat fever up until 4 hours<br />
after treatment. This evidence was of moderate to very low quality.<br />
A meta-analysis found no difference in the number of adverse events reported in children who<br />
received ibuprofen compared with children who received paracetamol to treat fever. The evidence for<br />
this finding was of very low quality.<br />
Paracetamol compared with paracetamol and ibuprofen combined<br />
One RCT found no difference in quality of life up to 5 days after treatment began between children<br />
who received paracetamol and ibuprofen combined compared with children who received<br />
paracetamol only to treat fever. The evidence for this finding was of low quality.<br />
230<br />
2013 Update
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