Efficacy of Ibuprofen Versus Acetaminophen for Acute Fever Management in Febrile Children: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Why clinicians should know about it

• Picked for Pediatrics and Child Health (paper of the day, 15 October 2026): Systematic review/meta‑analysis of antipyretic efficacy in febrile children

Abstract

BACKGROUND: Ibuprofen and acetaminophen are the most widely used antipyretic agents in pediatric practice. Despite their common use, comparative evidence on their relative efficacy in febrile children remains heterogeneous, and clinical recommendations vary across guidelines and countries. OBJECTIVE: We aimed to evaluate the comparative antipyretic efficacy of ibuprofen versus acetaminophen in febrile children through a systematic review and meta-analysis restricted to randomized controlled trials. METHODS: A systematic search was conducted in Scopus, PubMed, and Web of Science using a predefined strategy combining terms for ibuprofen, paracetamol/acetaminophen, fever/febrile/pyrexia, and pediatric populations. The primary outcome was the proportion of children afebrile at 4 h. Continuous outcomes included temperature reduction at 4 h, time without fever during the first 4 h, and time-weighted summary temperature differences over 0-8 h. The study protocol was registered in PROSPERO (CRD420261353471). RESULTS: A total of 479 records were identified; after duplicate removal and screening, seven studies were included in the quantitative synthesis. For the primary outcome of afebrile status at 4 h, the pooled risk ratio was 1.26 (95% confidence interval [CI] 0.88-1.80; p = 0.106). Temperature reduction at 4 h was significantly greater with ibuprofen (mean difference 0.31 °C, p = 0.024). The time-weighted summary temperature outcome over 0-8 h numerically favored ibuprofen but did not reach statistical significance (mean difference - 3.52, 95% CI - 21.24 to 14.21; p = 0.240; I2 = 57.6%). An exploratory standardized mean difference analysis across heterogeneous continuous outcomes (seven comparisons) yielded a near-null pooled effect (Hedges' g - 0.08, 95% CI - 0.40 to 0.25; p = 0.645; I2 = 84.0%). CONCLUSIONS: The primary outcome-the proportion of children achieving afebrile status at 4 h-did not differ significantly between ibuprofen and acetaminophen (risk ratio 1.26, 95% CI 0.88-1.80; p = 0.106). Ibuprofen produced a statistically greater reduction in temperature at 4 h compared with acetaminophen (mean difference 0.31 °C), although this difference is unlikely to be clinically meaningful. These findings suggest a marginal quantitative advantage of ibuprofen to decrease body temperature, without a clinically significant difference between the two agents.

Abstract as published, via PubMed.