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. 2021 Apr 21;47(1):98.
doi: 10.1186/s13052-021-01047-y.

Prescribing patterns, indications and adverse events of ibuprofen in children: results from a national survey among Italian pediatricians

Massimo Martinelli #  1 , Lucia Quaglietta #  2 , Giuseppe Banderali  3 , Pietro Ferrara  4   5 , Claudio Romano  6 , Annamaria Staiano  7
Affiliations

Prescribing patterns, indications and adverse events of ibuprofen in children: results from a national survey among Italian pediatricians

Massimo Martinelli et al. Ital J Pediatr. .

Abstract

Background: Despite ibuprofen widely recognized safety profile, an increase of suspected adverse events has been reported in the last decade in parallel with its growing over-the-counter use. The aims of this study were to assess the therapeutic approach to the feverish child and to evaluate the main indications and the most frequent adverse events related to ibuprofen administration in children.

Methods: A specific questionnaire-form regarding the management of ibuprofen therapy in children was distributed among a sample of pediatricians all over the Italian territory between September and October 2020. An electronic data collection through a specifically designed web-based platform was performed among the participating pediatricians.

Results: One-hundred-eighty-one pediatricians completed the survey. In case of fever, 177 (98%) participants prescribe paracetamol, while only 4 (2%) preferred ibuprofen as first choice. One-hundred-twenty-eight pediatricians (71%) administer paracetamol alone, while 53 (29.2%) use the combined/alternating treatment with ibuprofen. Ibuprofen is mostly administered for musculoskeletal pain (30%), upper respiratory tract infection (20%), headache (15%) and post-surgical pain (9%). Sixty-three (35%) out of 181 participating pediatricians reported 191 adverse events during ibuprofen administration. The most common were gastrointestinal (GI), with GI bleeding being reported in 30/191 cases (15.7%), epigastric pain in 29/191 (15.1%), non-specified abdominal pain in 22/191 (11.1%) and nausea/vomiting in 21/191 (11%). Severe adverse events including kidney damage (3.1%), complicated infections (0.5%), pneumonia associated empyema (0.5%), soft tissue infection (0.5%) and disseminated intravascular coagulation (0.5%) were also reported. The adverse events led to a hospitalization in 12% of children. In 53/191 cases (28%) the adverse events were related to a wrong dosage or prolonged therapy or errors in frequency of administration.

Conclusions: This survey demonstrate a sufficient awareness of Italian pediatricians regarding ibuprofen-prescribing patterns with the only possible concern related to the relatively high percentage of pediatricians performing a combining/alternating use of paracetamol and ibuprofen. The reported adverse events were mild in most of the cases and often related to errors in dosage, frequency and treatment duration, emphasizing the need for a major caution of both practitioners and patients in their use.

Keywords: Fever; Ibuprofen; NSAIDs; Pediatrics; Safety.

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Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
Management of feverish children among Italian Pediatricians. a Percentage of pediatricians prescribing paracetamol or ibuprofen as first-choice treatment for fever management; b Percentage of pediatricians using combined/alternating use of antipyretics; c Reasons for performing combined/alternating use of antipyretics in the feverish child
Fig. 2
Fig. 2
Ibuprofen: Indications, age and formulations. a Main indications for prescribing ibuprofen; b Starting age for Ibuprofen prescription; d Ibuprofen used formulations
Fig. 3
Fig. 3
Ibuprofen treatment: doses, length, schedule and association with other NSAIDs; a ibuprofen dosage per dose; b ibuprofen dosage per day; c treatment duration
See this image and copyright information in PMC

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