Pharmacological management of fever in children: ibuprofen versus acetaminophen - myths, evidence, and best practices

Abstract

Objectives. Fever is one of the most frequent reasons for presentation to pediatric services worldwide, yet its management remains inconsistent because of persistent misconceptions among caregivers and healthcare professionals. This narrative review examines the pathophysiology of fever and the comparative pharmacology, efficacy, and safety of ibuprofen and acetaminophen, the main pediatric antipyretics. Materials and methods. A targeted literature search was conducted in PubMed and international clinical guidelines to identify key randomized controlled trials, systematic reviews, meta-analyses, pharmacovigilance studies, and relevant guideline documents published predominantly over the last two decades. Results. Both drugs are effective and similarly safe when used at standard pediatric doses. Ibuprofen provides a modestly greater and more sustained reduction in temperature, whereas combined or alternating regimens provide only marginal antipyretic benefit while increasing dosing complexity and raising concerns regarding dosing errors and uncertain long-term safety. Specific clinical contexts, such as dehydration, varicella, asthma risk, and febrile seizures require individualized decision-making rather than uniform policies. Caregiver education regarding the physiological role of fever remains one of the most important interventions for reducing unnecessary antipyretic use and avoidable emergency visits. Conclusions. The primary goal of antipyretic therapy should shift from normalizing body temperature to improving the child's overall comfort. The choice of antipyretic should be individualized based on the clinical context. Addressing "fever phobia" through caregiver education is essential for rational and safe management in children.