Optimising pediatric paracetamol and ibuprofen use: a retrospective study with expert evaluation of efficacy, safety, and healthcare costs.

BACKGROUND

Paracetamol and ibuprofen are widely used for fever and pain in children, but real-world prescribing often deviates from guidelines, leading to potentially avoidable complications and healthcare costs.

OBJECTIVES

To estimate the clinical and economic burden associated with inappropriate use of paracetamol and ibuprofen in Italian pediatric care and to identify high-risk clinical scenarios in which safer prescribing may reduce complications.

METHODS

A retrospective analysis was conducted on national hospital discharge records (2010-2016), focusing on DRGs and ICD-9-CM codes linked to adverse events following antipyretic or NSAID use in children aged 0-17. A qualitative assessment was also carried out through expert consultation to contextualize findings.

RESULTS

Among 999,739 hospital discharges, 4,308 cases (0.43%) developed complications within three years. ENT procedures and renal diagnoses showed the highest complication rates and costs. Children under three accounted for the largest share of healthcare expenditure. A scenario analysis using pneumonia data suggested that up to 3,000 complications and €10 million in costs could be avoided with more selective NSAID use. Experts recommended prioritizing paracetamol in high-risk scenarios, including dehydration, respiratory infections, and varicella.

CONCLUSIONS

Inappropriate use of antipyretics in pediatric care is associated with a measurable clinical and financial burden. Greater adherence to prescribing recommendations, especially in vulnerable populations, can improve outcomes and reduce costs. Educating caregivers and harmonizing clinical practices are key priorities.