Antipyretic Management
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. Krudsood et al (22)
reported the area under the temperature curve (AUC-T°) for ibuprofen
(400 mg q6h) at 24h post-treatment, with a more significant reduction in
temperature in the IVIB group compared to the placebo group (7.49 ± 7.94
vs. 16.44 ± 11.60, P = 0.002). Promes et al (24) reported that the
AUC-T° for ibuprofen (800 mg q6h) during 24 hours post-treatment was
associated with a lower value than the placebo group (9.19 ± 7.6 vs
16.09 ± 11.5, P = 0.008). Morris et al (40) investigated the antipyretic
effect of IVIB (400 mg q4h) and discovered that the proportion of
patients whose temperature dropped below 101.0 °F within 4 hours was
significantly higher in the IVIB group than in the placebo group (24
patients: 77% vs. 9 patients: 32%, P = 0.0005). Promes et al (24) and
Morris et al (40) also reported AEs and severe adverse events (SAEs),
but all SAEs were not related to the drug. There were no statistical
differences in the incidence of AEs between the two groups.
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). 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.