Efficacy of IV Ibuprofen vs IV Paracetamol in the Treatment of Tonsillopharyngitis with Fever

Table of Content


Patients with upper respiratory tract infection (URTI) presenting to emergency department (ED) usually are accompanied with various symptoms, with fever being the most serious clinical sign. Fever might need treatment due to the occurrence of discomfort and high fever-based complications. Paracetamol has been widely used with its antipyretic effect starting after 30 mins of administration. The antipyretic effect of ibuprofen begins earlier may facilitate the early discharge of patient from ED.


This study compares the efficacy of IV paracetamol vs IV ibuprofen on reducing fever in adult patients with tonsillopharyngitis.


Study Design

  • Prospective, randomized controlled, double-blind, clinical study

Patient Profile

  • Patients aged 18-65 years presenting to ED with URTI symptoms and a tonsillopharyngitis assessment score of >5
  • Patients not consumed any antibiotic past one week and no antipyretic consumed in last 4 hr

Treatment Strategy

  • The cohort was randomized into 2 groups
    • Group 1 treated with IV paracetamol as 1000 mg in 150 ml normal saline as infusion (n=54)
    • Group 2 treated with IV ibuprofen 400 mg in 150 ml normal saline as infusion (n=50)


Primary Endpoint

  • Decrease in fever at 15, 30, and 60 min

Secondary Endpoint

  • Need for additional treatment after 60 min


  • The baseline characteristics between both the groups were similar
  • Changes in fever from the baseline at different time intervals are presented below as median (IQR 25-75)
  • No side effects were reported by the patients treated with IV ibuprofen and paracetamol.
Figure 1. Changes in fever from the baseline at different time intervals

  • The reduction in fever at 15 min was significantly more pronounced in the ibuprofen group (p=0.036)
  • Both the groups had remarkable reduction in fever at 30 min and 60 min (P ≤ 0.001 and P ≤ 0.001, respectively)
  • The fever drop from baseline at 60 min was similar in both the groups (p = 0.350
  • More patients in the paracetamol group required additional treatment as compared to the ibuprofen group (p=0.044)


  • Ibuprofen and paracetamol were effective in controlling fever at 30 min and 60 min
  • Ibuprofen was more effective in reducing fever in the first 15 min, and may enable a rapid discharge from the emergency department
  • No additional treatment was required in the ibuprofen treated patients.
  • Patients treated with IV Ibuprofen and IV paracetamol reported no side effects.

J Clin Med. 2023 Jan 4;12(2):396. Doi: 10.3390/jcm12020396.