PFAPA syndrome in children: A meta-analysis on surgical versus medical treatment

Int J Pediatr Otorhinolaryngol. 2010 Nov;74(11):1203-8. doi: 10.1016/j.ijporl.2010.08.014. Epub 2010 Sep 15.


Objective: To compare the range of medical and surgical therapies for children with PFAPA syndrome.

Methods: A literature search was performed using Medline, Embase, Ovid and Cochrane databases for studies between 1987 and 2010 that compared PFAPA treatment in children (surgical versus medical). Random-effect meta-analytical techniques were conducted for the outcome measures.

Results: The use of antibiotics and cimetidine in PFAPA syndrome are ineffective. However, there is evidence that the use of steroids is effective in the resolution of symptoms. Tonsillectomy (+/- adenoidectomy) as a treatment of PFAPA was found to be an effective intervention for resolution of symptoms (P<0.00001). Meta-analysis of surgery versus cimetidine and surgery versus antibiotics demonstrated that surgery is a significantly more effective treatment for PFAPA syndrome. A comparison of treatment with steroids or surgery did not show any statistically significant difference, confirming the effectiveness of both therapies for the resolution of PFAPA syndrome (P=0.83).

Conclusions: The most effective non-surgical therapy is corticosteroids. However, they do not prevent future fever cycles. The results of this meta-analysis showed that tonsillectomy (+/- adenoidectomy) is the most effective intervention for long-term resolution of PFAPA syndrome symptoms.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Adenoidectomy
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Cimetidine / therapeutic use
  • Fever / therapy*
  • Glucocorticoids / therapeutic use
  • Histamine H2 Antagonists / therapeutic use
  • Humans
  • Lymphadenitis / therapy*
  • Pharyngitis / therapy*
  • Stomatitis, Aphthous / therapy*
  • Syndrome
  • Tonsillectomy


  • Anti-Bacterial Agents
  • Glucocorticoids
  • Histamine H2 Antagonists
  • Cimetidine