Safety Comparison: Ibuprofen vs Rofenac (Diclofenac) for a 3-Year-Old with Bacterial Tonsillitis
Ibuprofen is the safer choice for a 3-year-old child with bacterial tonsillitis. 1
Primary Recommendation
Use ibuprofen at 5-10 mg/kg per dose, administered 3-4 times daily (maximum 30-40 mg/kg/day) for pain and fever management in this child. 2 Ibuprofen has been specifically identified as one of the safest NSAIDs for pediatric use, with paracetamol being the only comparably safe option. 1
Evidence Supporting Ibuprofen's Superior Safety Profile
Established Safety in Young Children
Ibuprofen is approved for use in children aged ≥3 months and has extensive safety data in this age group, making it appropriate for your 3-year-old patient. 2, 3
Multiple systematic reviews confirm ibuprofen's safety profile is comparable to paracetamol in children, with both being identified as the safest analgesic options. 1
Clinical experience demonstrates ibuprofen is better tolerated by children than adults and is safer in overdose than paracetamol and aspirin. 4
Diclofenac's Limited Pediatric Data
While diclofenac (Rofenac) shows slightly superior pain relief compared to paracetamol in adults with sore throat, no trials directly compared ibuprofen versus diclofenac, and the guideline specifically notes the lack of comparative data. 1
Diclofenac has significantly less safety data in young children compared to ibuprofen, particularly in the 3-year-old age group. 5
The evidence base for NSAIDs in pediatric tonsillitis primarily involves ibuprofen, not diclofenac, with large studies (>6,000 children) demonstrating ibuprofen's safety. 1
Practical Dosing for This Patient
Calculate the dose based on the child's weight: multiply weight in kg by 5-10 mg to get the per-dose amount. 2
Administer every 6-8 hours as needed, not exceeding 30-40 mg/kg total daily dose. 2
Ensure adequate hydration before and during ibuprofen use, as dehydration is the primary risk factor for renal adverse events. 3
Critical Safety Considerations
When NOT to Use Ibuprofen
Do not administer if the child has diarrhea, vomiting, or signs of dehydration, as this significantly increases risk of renal damage. 3
Contraindicated in children with wheezing, persistent asthma, or during varicella infection. 3
Avoid in children with known sensitivity to ibuprofen or other NSAIDs. 3
Duration of Treatment
Keep treatment duration as short as possible for acute conditions like tonsillitis, typically 3-5 days while symptoms persist. 3, 5
Ibuprofen should primarily be used for inflammatory pain management, not routinely as an antipyretic, though it can be used for fever when necessary. 3
Why Not Diclofenac?
The fundamental issue is lack of robust pediatric safety data for diclofenac in young children with acute infections. While the 2012 guideline notes diclofenac has slightly better analgesic efficacy than paracetamol in adults 1, this does not translate to a recommendation for pediatric use, especially when:
- Ibuprofen has decades of established safety data in children as young as 3 months 2, 3
- The risk-benefit profile strongly favors ibuprofen given its proven track record 1
- No comparative trials exist to suggest diclofenac offers meaningful advantages over ibuprofen in this population 1
Common Pitfalls to Avoid
Do not use weight-based dosing that exceeds 40 mg/kg/day total, as this increases adverse event risk without additional benefit. 2
Do not continue ibuprofen if the child develops gastrointestinal symptoms, decreased urine output, or signs of dehydration. 3
Do not assume all NSAIDs have equivalent safety profiles in children—ibuprofen's extensive pediatric data makes it uniquely positioned as the safest NSAID choice. 1, 5