The efficacy of suppository versus oral ibuprofen for reducing fever in children

Main Article Content

Suhesti Handayani
Sri Rezeki Hadinegoro
Sudigdo Sastroasmoro

Abstract

Background Ibuprofen suppository is used to reduce fever in
children who are unable to receive it orally. The effectiveness of
ibuprofen suppository compared to that of oral ibuprofen has not
been documented in Indonesian children.
Objective The aim of this study was to compare the efficacy of
ibuprofen suppository with that of oral ibuprofen for reducing
fever in children.
Methods This study was a randomized clinical trial without blind-
ing on children aged 2-5 years with body weight of 12.5 to 16 kg
who had fever. Subjects received ibuprofen in either oral (7.5
mg/kg) or suppository (125 mg) form. The temperature was mea-
sured prior to ibuprofen administration, 30 minutes afterwards,
and every subsequent half hour until the end of the sixth hour.
Any observed adverse effects were recorded.
Results Mean time needed for fever reduction was 2.72 (SD 1.1)
hours in the suppository group, compared to 3.43 (SD 0.9) hours
in the oral group (P=0.004). The mean rate of fever reduction in
the suppository group was 0.90 (SD 0.4) °C/hour, while in the
oral group it was 0.61 (SD 0.3) °C/hour. However, mean maxi-
mum temperature lowering ability did not differ significantly [2.11
(SD 0.7) °C for the suppository group and 1.99 (SD 0.7) °C, for
the oral group (P=0.489)]. There was no significant difference in
mean duration of effect [220.8 (SD 83.0) hours for the supposi-
tory group and 196.6 (SD 92.7) hours for the oral group (p=0.231)].
Conclusions There was no significant difference between both
preparations in maximum temperature lowering ability and dura-
tion of effect. Temperature reduction was significantly faster
with the administration of ibuprofen suppository

Article Details

How to Cite
1.
Handayani S, Hadinegoro S, Sastroasmoro S. The efficacy of suppository versus oral ibuprofen for reducing fever in children. PI [Internet]. 13Oct.2016 [cited 15Aug.2020];45(5):211-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/842
Section
Articles
Author Biographies

Suhesti Handayani

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

Sri Rezeki Hadinegoro

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

Sudigdo Sastroasmoro

Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
Received 2016-10-10
Accepted 2016-10-10
Published 2016-10-13

References

1. Dinarello CA, Wolff SM. Pathogenesis of fever and the
acute phase response. In: Mandell GL, Bennett JE, Dolin
R, editors. Principles and practice of infectious diseases.
4th ed. New York: Churchill Livingstone Inc; 1995. p.
530-6.
2. Abdoerrachman MH. Demam: Patogenesis dan
pengobatan. In: Soedarmo SSP, Garna H, Hadinegoro
SRS, editors. Buku ajar ilmu kesehatan anak, infeksi
dan penyakit tropis. 1st ed. Jakarta: Balai Penerbit FKUI;
2002. p. 28-51.
3. Kelley MT, Walson PD, Edge JH, Cox S, Mortensen ME.
Pharmacokinetics and pharmacodynamics of ibuprofen
isomers and acetaminophen in febrile children. Clin
Pharmacol Ther 1992;52:181-9.
4. Kokki H, Hendolin H, Maunuksela EL, Vainio J,
Nuutinen L. Ibuprofen in the treatment of postoperative
pain in small children. A randomized double blind pla-
cebo controlled parallel group study. Acta Anaesthesiol
Scand 1994;38:467–72.
5. Van Hoogdalem E, de Boer AG, Breimer DD. Pharma-
cokinetics of rectal drug administration, part I. General
consideration and clinical applications of centrally act-
ing drugs. Clin Pharmakokinet 1991;21:11-26.
6. Committee on Drugs American Academy of Pediatrics.
Alternative routes of drug administration, advantages
and disadvantages [subject review]. Pediatrics
1997;100:143-52.
7. Mc Intyre J, Hull D. Comparing efficacy and tolerability
of ibuprofen and paracetamol in fever. Arch Dis Child
1996;74:164-7.
8. American Hospital Formulary Service (AHFS). Drug
Information . Ibuprofen. AHFS; 2003.
9. Kauffmann RE, Nelson MV. Effect of age on ibuprofen
pharmacokinetics and antipyretic response. J Pediatr
1992;12:969-73.
10. Walson PD, Galletta G, Chomilo F, Braden NJ, Sawyer
LA, Scheinbaum ML. Comparison of multidose ibuprofen
and acetaminophen therapy in febrile children. AJDC
1992;146:636-2.
11. Amdekar YK, Desai RZ. Antipyretic activity of ibuprofen
and paracetamol in children with pyrexia. British J Clin
Prac 1985:39;140-3
12. Bagian Farmakologi Klinik Fakultas Kedokteran Uni-
versitas Gadjah Mada Yogyakarta. Ketersediaan hayati
terbanding sediaan ibuprofen: Proris® supositoria 125 mg
vs Advil® sirup 100mg/ 5 ml. Laporan penelitian.
FKUGM; 1994.
13. Maunuksela EL, Ryhänen P, Janhunen L. Efficacy of rectal
ibuprofen in controlling postoperative pain in children.
Can J Anaesth 1992;39(3):226-30.
14. Autret E, Breot G, Jonville AP, Courcier S. Lassole C,
Goehrs JM. Comparative efficacy and tolerance of
ibuprofen syrup and acetaminophen syrup in children
with pyrexia associated with infectious diseases and
treated with antibiotic. Eur J Clin Pharmacol 1994;46:197-
201.
15. Furst DE, Munster T. Nonsteroidal anti-inflammatory
drugs, disease-modifying antirheumatic drugs, nonopioid
analgesics & drugs used in gout. In: Katzung BG, editor.
Basic and clinical pharmacology. 8th ed. New York: Lange
Medical Books/McGraw-Hill; 2001. p. 596-623.
16. Flower RJ, Moncada S, Vane JR. Analgesic-antipyretics
and anti-inflammatory agents. In: Goodman LS, Gilman
AG, Rall TW, editors. Goodman and Gilman’s the phar-
macological basis of therapeutics. 8th ed. New York:
Macmillan; 1993. p. 639-81.
17. Gianini EH, Brewer EJ, Miller ML, Gibbas D, Passo MH,
Hoyeraal HM, et al. Ibuprofen suspension in the treat-
ment of juvenile rheumatoid arthritis. J Pediatr
1990;117:645-52.
18. Coulthard KP, Nielson HW, Schroder M, Covino A,
Matthews NT, Murray RS, et al. Relative bioavailability
and plasma paracetamol profiles of Panadol suppositories
in children. J Paediatr Child Health 1998;34:425-31.
19. Lee CY, Finkler A. Acute intoxication due to ibuprofen
overdose. Arch Pathol Lab Med 1986;110:747-9.
20. Perrott DA, Piira T, Goodenough B, Champion D. Effi-
cacy and safety of acetaminophen versus ibuprofen for
treating children’s pain or fever. Arch Pediatr Adolesc
Med 2004;158:521 – 6.