Antipyretic Effectiveness of Oral Acetaminophen Versus Rectal Acetaminophen in Pediatric Patients With Fever

Author:

Tantivit Nessa1,Thangjui Sittinun2,Trongtorsak Angkawipa3

Affiliation:

1. aDepartment of Pediatrics, University of South Alabama, Mobile, Alabama

2. bDepartment of Internal Medicine, Bassett Healthcare Center, Cooperstown, New York

3. cDepartment of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, Illinois

Abstract

BACKGROUND AND OBJECTIVE Acetaminophen, one of the routine medicines used for temperature reduction in febrile children, is available in multiple routes of administration, including oral and rectal routes. Our objective is to compare the antipyretic effectiveness of oral acetaminophen versus rectal acetaminophen in pediatric patients with fever in terms of temperature reduction. METHODS Medline and Embase databases were searched from inception to August 2021. Cohort studies, case-control studies, experimental studies, and randomized controlled trial studies comparing oral and rectal administered acetaminophen in pediatric patients were included. Two reviewers independently extracted data. RESULTS A total of 5 randomized studies (n = 362) were included in the meta-analysis. No significant difference was found between oral and rectal acetaminophen in temperature reduction at 1 hour (weighted mean difference [WMD], 0.04°C; 95% confidence interval [CI], −0.10°C to 0.19°C; P = .501) or 3 hours (WMD, −0.14°C; 95% CI, −0.37°C to 0.10°C; P = .212) after administration (WMD, −0.14°C; 95% CI, −0.37°C to 0.10°C; P = .212). CONCLUSION Oral and rectal acetaminophen have no significant difference in antipyretic effectiveness at 1 and 3 hours after administration. If both options are available, oral acetaminophen would be preferred because of a more predictable drug level after administration. However, for febrile children with specific circumstances for whom oral acetaminophen could not be administered, rectal acetaminophen may be an alternative option for a short period of time (<48 hours).

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics,General Medicine,Pediatrics, Perinatology and Child Health

Reference20 articles.

1. Fever and antipyretic use in children;Sullivan;Pediatrics,2011

2. Acetaminophen toxicity in children;American Academy of Pediatrics. Committee on Drugs;Pediatrics,2001

3. Antipyretic therapy. Comparison of rectal and oral paracetamol;Keinänen;Eur J Clin Pharmacol,1977

4. Rectal paracetamol in small children with fever;Vernon;Arch Dis Child,1979

5. Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children;Scolnik;Pediatrics,2002

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