Intravenous and Oral Paracetamol Have the Same Effect in Reducing Fever in Pediatric Patients

Fitri Asymida, Yazid Dimyati, Bidasari Lubis, Aznan Lelo, Muhammad Ali, Ayodhia Pitaloka Pasaribu, Syahril Pasaribu


Background: The antipyretic effect of intravenous versus oral paracetamol is not well known. This study was aimed to compare the antipyretic effect of intravenous and oral paracetamol therapy to reduce fever.

Materials and Methods: This was an open-label randomized clinical trial study. The subjects were children who presented to Pediatric Ward and Emergency of Haji Adam Malik Hospital, aged from 2 months to 18 years old, with axillary temperature ≥38.0ºC. Subjects were divided into two groups, group 1 received 15 mg/kg paracetamol intravenous and group 2 received the same dose of paracetamol but given through intravenous. The temperature reduction was analyzed by ANOVA, and the change in temperature was recorded at 0, 15, 30, 60, 120, and 180 minutes after drug administration.

Results: In the first group, the mean temperature was decreased (p<0.001) from 15 to 180 minutes after the administration of paracetamol. Nausea was documented as the adverse effect for both oral and intravenous administration groups.

Conclusion: The administration of 15 mg/kg paracetamol, either though intravenous or oral, have similar effect in reducing fever in children. Paracetamol therapy though intravenous route can be given if it cannot be given orally.

Keywords: antipyretic, pediatrics, fever, intravenous, oral, paracetamol

Full Text:



Green RJ, Pentz A. Fever in children: how to minimize risk and provide appropriate therapy. S Afr Fam Pract. 2014; 56(4): 212-5, CrossRef.

Sullivan JE, Farrar HC. Fever and antipyretics use in children. Pediatrics. 2011; 127(3): 580-7, CrossRef.

El Radhi AS, Carrol J, Klein N. Clinical manual of fever in children. Berlin: Springer; 2009, article.

World Health Organization. Integrated Management of Childhood Illness. Geneva: World Health Organization; 2000, article.

El-Radhi AS. What is the evidence not affecting the practice of fever management? Arch Dis Child. 2008; 93(11): 918-20, CrossRef.

Hoque I, Chatterjee A, Bhattacharya S, Biswas R, Auddy S, Mondal K. A review on different types of the non steroidal anti-Inflammatory drugs (NSAIDs). Int J Adv Multidiscip Res. 2016; 3(9): 41-51, CrossRef.

Plaisance KI, Mackowiak PA. Antipyretic therapy: Physiologic rationale, diagnostic implications, and clinical consequences. Arch Intern Med. 2000; 160(4): 449-56, CrossRef.

Oscier C, Bosley N, Milner Q. Paracetamol - A review of three routes of administration. Anaesth. 2007; 23: 112-4, article.

Roy S, Simalti AK. Comparison of antipyretic efficacy of intravenous (IV) acetaminophen versus oral (PO) acetaminophen in the management of fever in children. Indian J Pediatr. 2018; 85(1): 1-4, CrossRef.

Paramba FC, Naushad VA, Purayil N, Mohammed OH, Chandra P. Randomized controlled study of the antipyretic efficacy of oral paracetamol, intravenous paracetamol, and intramuscular diclofenac in patients presenting with fever to the emergency department. Ther Clin Risk Manag. 2013; 9: 371-6, CrossRef.

Aronoff DM, Neilson EG. Antipyretics: mechanisms of action and clinical use in fever suppression. Am J Med. 2001; 111(4): 304-15, CrossRef.

Feverish illness in children. Assesment and management in children younger than 5 years. London: National Institute for Health and Clinical Excellene; 2007, article.

Peacock WF, Breitmeyer JB, Pan C, Smith WB, Royal MA. A randomized study of the efficacy and safety of intravenous acetaminophen compared to oral acetaminophen for treatment of fever. Acad Emergency Med. 2011; 18(4): 360-6, CrossRef.

Gupta H, Shah D, Gupta P, Sharma KK. Role of paracetamol in treatment of childhood fever: A double-blind randomized placebo controlled trial. Indian Pediatrics. 2007; 44(12): 903-11, article.

Jayawardena S, Kellstein D. Antipyretic efficacy and safety of ibuprofen versus acetaminophen suspension in febrile children: Results of 2 randomized, double-blind, single-dose studies. Clin Pediatr. 2017; 56(12): 1120-7, CrossRef.

Bourboulis EJ, Spyridaki A, Savva A, Georgitsi M, Tsaganos T, Mauktaroudi M, et al. Intravenous paracetamol as an antipyretic and analgesic Medication: the significance of drug metabolism. J Pharmacol Sci. 2014; 124(2): 144-52, CrossRef.

Gibb IA, Arderson BJ. Paracetamol (acetaminophen) pharmacodynamics : interpreting the plasma concentration. Arch Dis Child. 2008; 93: 241-7, CrossRef.

Divoll M, Greenblatt DJ, Ameer B, Abernethy DR. Effect of food on acetaminophen absorption in young and erderly subjects. J Clin Pharmacol. 1982; 22(11-12): 571-6, CrossRef.

Temple AR, Zimmerman B, Gelotte C, Kuffner EK. Comparison of the efficacy and safety of 2 acetaminophen dosing regimens in febrile infants and children : a report on 3 legacy dtudies. J Pediatr Pharmacol Ther. 2017; 22(1): 22-32, CrossRef.

Temple AR, Temple BR, Kuffner EK. Dosing and antipyretic efficacy of oral acetaminophen in children. Clin Ther. 2013; 35(9): 1361-75, CrossRef.

Scolnik D, Kozer Z, Jacobson S, Diamond, Young NL. Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children. Pediatrics. 2002; 110(3): 553-6, CrossRef.

Kett DH, Breitmeyer JB, Ang R, Royal MA. A Randomized study of the efficacy and safety of intravenous acetaminophen vs. intravenous placebo for the treatment of fever. Clin Pharmacol Ther. 2011; 90(1): 32-9, CrossRef.

Fox ER, Jones VM, Beckwith MC. Acetaminophen injection: A review of clinical information including forms not available in the United States. J Pain Palliat Care Pharmacother. 2012; 26: 115-7, CrossRef.

Jibril F, Sharaby S, Mohammed A, Wilby KJ. Intravenous versus oral acetaminophen for pain: systematic review of current evidence to support clinical decision-making. Can J Hosp Pharm. 2015; 68(3): 238-4, CrossRef.

Graham GG, Scott KF, Day RO. Tolerability of paracetamol. Drug safety. 2005; 28(3): 227-40, CrossRef.


Indexed by:




Cell and BioPharmaceutical Institute