From the Research
For a 28 kg pediatric patient with chronic non-bacterial osteomyelitis (CNO), the recommended ibuprofen dose is 10 mg/kg per dose, given every 6-8 hours, which translates to approximately 280 mg per dose, given three to four times daily. This recommendation is based on the most recent and highest quality study available, which compared the efficacy and safety of ibuprofen and acetaminophen in children younger than 2 years 1. The study found that ibuprofen resulted in reduced temperature and less pain within the first 24 hours of treatment, with equivalent safety to acetaminophen.
Key Considerations
- Ibuprofen should be administered with food to minimize gastrointestinal side effects.
- The duration of treatment typically ranges from 6-12 months, with regular monitoring of clinical response and potential side effects.
- NSAIDs like ibuprofen are considered first-line therapy for CNO because they address the underlying inflammatory process by inhibiting prostaglandin synthesis.
- Regular follow-up is essential to assess treatment efficacy, with clinical improvement typically expected within 1-2 months.
- If inadequate response occurs after 1-2 months of appropriate NSAID therapy, consultation with a pediatric rheumatologist is recommended to consider alternative or additional treatments.
Supporting Evidence
- A meta-analysis of 17 blinded, randomized controlled trials found that ibuprofen (4-10 mg/kg) and acetaminophen (7-15 mg/kg) had similar efficacy for relieving moderate to severe pain, and similar safety as analgesics or antipyretics 2.
- A systematic review and meta-analysis of 19 studies found that ibuprofen resulted in reduced temperature and less pain within the first 24 hours of treatment, with equivalent safety to acetaminophen in children younger than 2 years 1.
- A qualitative review of 85 studies found that ibuprofen was more efficacious than acetaminophen for the treatment of pain and fever in both pediatric and adult populations, and that these 2 drugs were equally safe 3.