Acetaminophen and ibuprofen for prevention of adverse reactions associated with childhood immunization.

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.