Acetaminophen and ibuprofen are commonly being used in an alternating manner for management of fever. There is presently no scientific evidence that this combination is safe or achieves faster antipyresis than either agent alone. There is evidence that the improper use of these agents may cause harm. Despite 29% of participants citing American Academy of Pediatrics recommendations as the basis for fever management, no such policy or recommendations exist. The observation that this practice is more common in younger practitioners may reflect their continued anxiety about fever (fever phobia). Until properly controlled studies have assessed the risk of combining these 2 products, practitioners should proceed with caution.
A case is reported of an infant who experienced seizures while being treated with a topical lidocaine 2% solution (Xylocaine 2% Viscous) for teething. The pharmacology of lidocaine is reviewed to alert physicians to the potential dangers of topical mucosal application of these preparations.
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