title: Double blind comparison of ibuprofen and paracetamol for adjunctive treatment of uncomplicated typhoid fever.
abstract: BACKGROUND
  Antipyretics reduce the prolonged, high fever characteristic of typhoid fever. The benefits of nonsteroidal drugs in this role have not been quantified. There have been concerns about the safety of antipyretics in typhoid.
  
  
  METHODS
  In a double blind randomized study, 80 Vietnamese children with uncomplicated typhoid fever were randomized to receive identical syrup preparations of ibuprofen (10 mg/kg) or paracetamol (12 mg/kg) every 6 h until 36 h after defervescence. Children with a nalidixic acid-susceptible (Na) isolate of Salmonella typhi were treated with ofloxacin (15 mg/kg/day) for 3 days and those with a nalidixic acid-resistant (Na) isolate were treated for 7 days.
  
  
  RESULTS
  S. typhi was isolated from 36 of 40 children randomized to ibuprofen (11 isolates Na) and 37 of 40 randomized to paracetamol (13 isolates Na). The median (range) fever clearance time (hours) was shorter in the ibuprofen group than the paracetamol group (68, 4 to 260 vs. 104, 12 to 404; P = 0.055) as was the area under the temperature time curve above 37 degree C (74, 0 to 237 vs. 127, 0 to 573; P = 0.013). The differences occurred predominantly in the children infected with a NaS. typhi whose infections responded more slowly to antibiotic treatment. There were no major side effects associated with the use of either drug. There were no differences between the two treatment arms in the concentrations of circulating interleukin-6 and tumor necrosis factor alpha during the course of treatment.
  
  
  CONCLUSIONS
  The antipyretic effect of ibuprofen is superior to that of paracetamol in children with typhoid fever, particularly those with prolonged fever. Both antipyretics appeared to be safe.
authors.affiliation: Hospital for Tropical Diseases and University of Oxford-Wellcome Trust Clinical Research Unit, Chi Minh City, Vietnam.
authors.forename: Ha
authors.initials: H
authors.lastname: Vinh
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
authors.forename: Vo Thi Ngoc
authors.initials: VT
authors.lastname: Hanh
authors.forename: Mai Thu
authors.initials: MT
authors.lastname: Chinh
authors.forename: Deborah
authors.initials: D
authors.lastname: House
authors.forename: Cao Thi
authors.initials: CT
authors.lastname: Tham
authors.forename: Nguyen Thi Thu
authors.initials: NT
authors.lastname: Thao
authors.forename: To Song
authors.initials: TS
authors.lastname: Diep
authors.forename: John
authors.initials: J
authors.lastname: Wain
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use*; D008297:Male; D015242:Ofloxacin / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014435:Typhoid Fever / Q000188:drug therapy*
chemical_list: D000890:Anti-Infective Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D015242:Ofloxacin; D007052:Ibuprofen