Objective: To summarize the existing evidence on the efficacy of therapy with alternating antipyretics compared to monotherapy in the management of fever in children.Sources: MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, IBECS, Web of Science, Clinical Trials, Google Scholar and references of the articles found. The review included randomized clinical trials published until December 2011, in which one of the arms was the alternating antipyretics therapy to treat fever in children younger than 12 years, treated on an outpatient basis. Data selection and extraction were performed independently by two reviewers. The quality of the studies was assessed according to CONSORT items. Summary of the findings:The selected studies showed great heterogeneity of participants, temperature for fever diagnosis, interventions (dose and dosing intervals) and assessed outcomes. The treatment groups ranged from 38 to 464 children. The studies compared paracetamol and ibuprofen alternated with paracetamol and/or ibuprofen. Only one study used different doses from the 15 mg/kg for paracetamol and 10 mg/kg for ibuprofen, but the dosing intervals varied considerably. The alternate use with dipyrone or acetylsalicylic acid was not assessed by any of the studies. Overall, the articles pointed to a tendency of lower mean temperatures in groups with alternating therapy. Few adverse effects were reported. Conclusion:Although there was a tendency towards the reduction of mean temperatures with alternating antipyretics compared to the use of one antipyretic alone, there is not enough evidence to say that alternating antipyretic therapy is more effective than monotherapy.J Pediatr (Rio J), 2012;88(4):289-96: Fever, children, antipyretics, efficacy, alternating therapy, review. ResumoObjetivo: Sumarizar as evidências existentes sobre a eficácia da terapia alternada com antipiréticos no manejo da febre em crianças comparada com monoterapia.Fontes de dados: MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, IBECS, Web of Science, Clinical Trials, Google Scholar e referências dos artigos encontrados. Foram incluídos na revisão ensaios clínicos randomizados, publicados até dezembro de 2011, em que um dos braços fosse terapia alternada com antipiréticos para tratamento de febre em crianças menores de 12 anos, atendidas em nível ambulatorial. A seleção e extração dos dados foram realizadas independentemente por dois revisores. A qualidade dos estudos foi avaliada de acordo com os itens do CONSORT. Síntese dos dados:Os estudos selecionados apresentaram grande heterogeneidade em relação aos participantes, temperatura para diagnóstico de febre, intervenções (doses e intervalos entre doses) e desfechos avaliados. Os grupos de tratamento variaram de 38 a 464 crianças. Os estudos compararam paracetamol e ibuprofeno alternados com paracetamol e/ou ibuprofeno. Em apenas um estudo foram utilizadas doses diferentes de 15 mg/kg para paracetamol e 10 mg/kg para ibuprofeno, mas os intervalos entre doses variaram consideravelmente. Em nenhum estudo fo...
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