Comparative evaluation of the efficacy of intravenous paracetamol and ibuprofen on the treatment of tonsillopharyngitis with fever

Abstract

OBJECTIVE: Tonsillopharyngitis is one of the constituents of upper respiratory tract infection (URTI). Fever is a URTI symptom requiring treatment due to the occurrence of discomfort and high fever-based complications. This study primarily sets out to observe and compare the efficacy of intravenous administration of paracetamol and ibuprofen drugs on fever in adult patients with tonsillopharyngitis. METHODS: This study was performed in a prospective, randomized controlled, double-blind design. The study population was divided as Group 1 (treated with paracetamol) and as Group 2 (treated with ibuprofen). While the first group was treated with paracetamol as 1000 mg in 150 ml normal saline, the second group was treated with ibuprofen as 400 mg in 150 ml normal saline. The primary outcome was the decrease in fever at 15, 30, and 60 min, while the secondary outcome was the need for additional treatment after 60 min. RESULTS: One hundred and eighty-five patients were included in the final analysis. The mean age of the paracetamol group (57.4% male) was 28.36 ± 9.6, whereas that of the ibuprofen group (54.9% male) was 27.45 ± 7.98. Fever was reduced significantly between 0 and 60 min in both groups (P ≤ 0.001 and P ≤ 0.001, respectively). Although the antipyretic effect of ibuprofen was more pronounced in the early period than that of paracetamol, no significant difference was noted between the two groups in terms of fever drop between 0 and 60 min (P = 0.350). CONCLUSION: Although both drugs prove effective in controlling fever at the 60 min, stronger efficacy of ibuprofen in the first 15 min may enable rapid discharge from the emergency department.

Intravenous Ibuprofen in Postoperative Pain and Fever Management in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…No deaths or IVIB-related SAEs were reported (72,73). Also, studies assessed the safety and acceptability of 5-to 10-minute infusion of IVIB and found that it appeared a faster efficacy in reducing fever compared to acetaminophen administered at a regular pace (41,66). IVIB rapid infusion was therefore proved be well tolerated and proved additional benefits in the perioperative period and emergent situations.…”

“…However, Can et al (36) found that there was no difference in the antipyretic effect between IVIB and intravenous acetaminophen 30 minutes after administration (P = 0.980). Additionally, Oncel et al (41) found that IVIB was more effective in reducing temperature than intravenous acetaminophen at 15 minutes after administration (median: 0.60 vs 0.40, P = 0.036), whereas there was no difference in the changes of the fever at 60 minutes (median: 1.5 vs 1.5, P = 0.350). No drug-related AEs were reported in either study.…”

“…56.3% of trials (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) had an unclear risk of bias owing to insufficient information about random sequences, allocation concealment, and the blinding of participants, personnel, and outcome assessors. 28.1% of trials (40)(41)(42)(43)(44)(45)(46)(47)(48) showed a low risk of bias and 15.6% of trials (49-53) had a high risk of blinding of participants and personnel, selective reporting, or other bias.…”

“…Five RCTs (22,24,36,40,41) discussed the antipyretic efficacy of IVIB in adult patients with severe (malaria and burns) or non-severe illnesses (tonsillopharyngitis and emergency fever). Three of the studies (22,24,40) compared the efficacy and safety of IVIB with placebo, and we conducted descriptive analysis only.…”

“…Two studies (36,41) compared the antipyretic effect of a single dose of IVIB (400 mg) with that of acetaminophen (1000 mg), both of which showed a better antipyretic effect and a significant reduction in temperature from baseline (Can et al, P = 0.001; Oncel et al, P < 0.001). However, Can et al (36) found that there was no difference in the antipyretic effect between IVIB and intravenous acetaminophen 30 minutes after administration (P = 0.980).…”