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A Meta-analysis

Lee Hilary Goldstein, MD; Maya Berlin, BPharmSce; Matitiahu Berkovitch, MD; Eran Kozer, MD

Arch Pediatr Adolesc Med. 2008;162(11):1042-1046.

Objective  To determine, on the basis of published studies, the efficacy of rectal vs oral acetaminophen as treatment of fever and pain.

Data Sources  MEDLINE, PubMed, and the Cochrane database as well as major pharmacologic textbooks and the references of all included studies were searched for studies comparing oral and rectal administration of acetaminophen.

Study Selection  Randomized and quasi-randomized controlled studies comparing rectal and oral administration of acetaminophen were included. Reviews, letters, and studies that compared combined treatments or additional drugs were excluded.

Main Exposure  Oral vs rectal acetaminophen.

Main Outcome Measures  Standardized measures of temperature and pain reduction.

Results  For temperature reduction, 4 studies met the inclusion criteria. The decline in temperature 1 hour after administration of acetaminophen was no different between rectal and oral administration (weighted mean difference [WMD], –0.14°C; 95% confidence interval [CI], –0.36°C to 0.08°C; P for heterogeneity = .49). There was no difference in the decline of temperature 3 hours after administration (WMD, –0.10°C; 95% CI, –0.41°C to 0.21°C; P = .84), the maximum decline in temperature (WMD, –0.10°C; 95% CI, –0.24°C to 0.04°C; P > .99), or the average time to temperature reduction of 1°C (WMD, –0.06°C; 95% CI, –1.34°C to 1.23°C; P < .001). We did not perform a meta-analysis comparing rectal and oral acetaminophen for pain reduction because only 1 study fulfilled the inclusion criteria.

Conclusions  Rectal and oral acetaminophen are comparable with respect to temperature reduction. The American Academy of Pediatrics recommendation to refrain from rectal acetaminophen in children should possibly be revised.

Author Affiliations: Medicine C, Haemek Medical Center, Afula, Israel (Dr Goldstein); and Clinical Pharmacology and Toxicology Unit (Ms Berlin and Dr Berkovitch) and Pediatrics Emergency Ward (Dr Kozer), Assaf Harofeh Medical Center, Zerrifin, Israel.

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