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.