Drug combinations bring fever down

Young children suffering with fever get better faster when treated with ibuprofen than with paracetamol, according to media reports. But they recover even more quickly if treated with both drugs. By Emma Baines.

Scientists found that alternating paracetamol and ibuprofen is safe, and can reduce the duration of a child's fever by nearly five hours, the papers said.

What is the research?
The media reports are based on a study in which 156 children with fever were treated with either paracetamol alone, ibuprofen alone, or paracetamol plus ibuprofen for up to 48 hours.

The children were aged between six months and six years and had a temperature of 37.8-41 degsC. In the first four hours, temperature was reduced faster and for 39 minutes longer in the children given ibuprofen than those given paracetamol.

Over 24 hours, children given both drugs had 4.4 fewer hours with fever than those given paracetamol alone, and 2.5 fewer hours than those given ibuprofen alone. There was no difference in the amount of discomfort suffered after 48 hours and adverse events between the groups were similar.

What do the researchers say?
The researchers advised that doctors, nurses, pharmacists and parents wanting to treat children with a fever should use ibuprofen first.

They said that the benefits and risks of using both ibuprofen and paracetamol over a 24-hour period should be considered.

However, they emphasised that the risk of accidentally exceeding the recommended dose of antipyretic treatment was raised by using two drugs.

What do other experts say?
'It's an interesting finding, but it doesn't alter the advice that should be given to parents,' said Berkshire GP Dr James Cave, a member of the NICE development group for guidance on feverish illness in children.

NICE guidance issued in May 2007 recommends either paracetamol or ibuprofen as an option if a child with fever appears distressed or is unwell. But it does not support the use of both drugs together. This recommendation was made partly because of safety concerns, but also because using both drugs was not cost-effective.

Dr Cave added that treating fever does not affect clinical outcomes, and parents should not feel obliged always to give antipyretics to children with fever.

'If children with a fever are distressed, you can give them paracetamol or ibuprofen, but there is no evidence that lowering their temperature with antipyretics will make them better any faster,' he said.

He added that there was some evidence that reducing the duration of a fever could slow down recovery from illness.

GPletters@haymarket.com

BMJ 2008; 337: a1302

Informing patients

  • Ibuprofen lowers temperature in children faster than paracetamol.
  • Alternating paracetamol and ibuprofen shortens the duration of fever.
  • Combined treatment is not recommended for children with fever because the benefits do not outweigh the costs.
  • Children with fever do not need antipyretic treatment unless they are distressed.

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