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DRUG INFORMATION ROUNDS

Acetaminophen and Ibuprofen for Prevention of Adverse Reactions Associated with Childhood Immunization

Leslie Dan Faculty of Pharmacy, Graduate Department of Pharmaceutical Sciences, University of Toronto, and Department of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada

Anna Taddio, PhD

Senior Scientist, Department of Child Health Evaluative Sciences; Clinical Specialist, Department of Pharmacy, The Hospital for Sick Children; and Graduate Faculty, Leslie Dan Faculty of Pharmacy, University of Toronto

Reprints: Dr. Taddio, Graduate Department of Pharmaceutical Sciences, University of Toronto, 555 University Ave., Toronto, ON, Canada M5G 1X8, fax 416/783-5263, anna.taddio{at}sickkids.ca

OBJECTIVE: To evaluate the literature examining prophylactic use of acetaminophen and ibuprofen for prevention of adverse reactions associated with childhood immunization.

DATA SOURCES: Articles were identified via MEDLINE/PubMed/EMBASE (1966-March 2007) using the following key terms: vaccination, immunization, diphtheria-tetanus toxoids-whole pertussis (DTwP), diphtheria tetanus-toxoid, whole pertussis, diphtheria-tetanus toxoids-acellular pertussis (DTaP), acellular pertussis, Haemophilus influenzae type B, inactivated poliovirus, pneumococcal 7-valent conjugate, measles, mumps, rubella, meningococcal C-conjugate, varicella zoster, hepatitis B, influenza, pneumococcal polysaccharide, adverse reactions, analgesics, antipyretics, acetaminophen, ibuprofen, infant, and child.

STUDY SELECTION AND DATA EXTRACTION: No limitations were placed on article selection.

DATA SYNTHESIS: Five articles examining the effects of prophylactic acetaminophen or ibuprofen for adverse effects associated with either DTaP or DTwP vaccine were retrieved. In one randomized controlled trial of children aged 4-6 years given DTaP, no effect of prophylactic acetaminophen 15 mg/kg/dose, up to 450 mg, or ibuprofen 10 mg/kg/dose, up to 300 mg, was found on the incidence of fever, redness, pain, swelling, or itching. In 3 randomized studies of DTwP, either acetaminophen 10-15 mg/kg/dose or ibuprofen 20 mg/kg/24 hours, given in 3 equal doses before or at the time of immunization and every 4-8 hours thereafter for 12 or more hours, reduced fever, pain, fussiness, and local redness in infants 2-7 months of age compared with placebo. Results were not duplicated in older infants/children. No studies investigated use of prophylactic acetaminophen or ibuprofen for any other vaccine.

CONCLUSIONS: Use of prophylactic acetaminophen and ibuprofen may reduce the incidence of adverse reactions in young infants receiving DTwP vaccine; however, DTwP has been replaced with DTaP, and no benefits have been demonstrated for this vaccine when evaluated in children aged 4-6 years, or with any other vaccine currently in use. Thus, neither drug can be recommended prophylactically to prevent vaccine-associated adverse reactions. Individuals at high risk for seizures may, however, warrant special consideration.

Key Words: acellular pertussis, acetaminophen, diphtheria tetanus toxoid, ibuprofen, whole pertussis

Published Online, May 22, 2007. www.theannals.com, DOI 10.1345/aph.1H647