• Brady S Moffett, Kristina Gutierrez, Kasey Davis, Binayak Sigdel, and Nathaniel Strobel.
• Department of Pharmacy, Texas Children's Hospital, Houston, TX.
• Pediatr Crit Care Me. 2019 Aug 1; 20 (8): e386-e393.

ObjectivesTo determine the antipyretic efficacy of acetaminophen (IV, enteral, rectal) and ibuprofen (enteral) in critically ill febrile pediatric patients.DesignRetrospective cohort study.SettingQuaternary care pediatric hospital ICUs.PatientsPediatric patients less than 19 years old who were febrile (≥ 38.0°C), received a dose of IV acetaminophen, enteral acetaminophen, rectal acetaminophen, or enteral ibuprofen and had at least one temperature measurement in the following 6 hours.InterventionsNone.Measurements And Main ResultsA total of 3,341 patients (55.8% male, median age 2.5 yr [interquartile range, 0.63-9.2 yr]) met study criteria. Baseline temperature was median 38.6°C (interquartile range, 38.3-38.9°C) measured via axillary (76.9%) route. Patients became afebrile (87.5%) at median 1.4 hours (interquartile range, 0.77-2.3 hr) after the first dose of medication, a -2.9 ± 1.6% change in temperature. Antipyretic medications included as follows: enteral acetaminophen (n = 1,664), IV acetaminophen (n = 682), rectal acetaminophen (n = 637), and enteral ibuprofen (n = 358). Enteral ibuprofen had a significantly greater odds of defervescence on multivariable logistic regression analysis (p = 0.04) with a decrease of -1.97 ± 0.89°C while IV acetaminophen was significant for a decreased time to defervescence at median 1.5 hours (interquartile range 0.8-2.3 hr) after a dose (p = 0.03). Patient age, presence of obesity, and baseline temperature were significant for decreased antipyretic efficacy (p < 0.05).ConclusionsEnteral ibuprofen was the most efficacious antipyretic and IV acetaminophen had the shortest time to defervescence.

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