Alternating antipyretics in the treatment of fever in children: a systematic review of randomized clinical trials

Abstract

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...

Management of acute fever in children: Guideline for community healthcare providers and pharmacists

“…[2,[8][9][10][11][12][13][14] (Evidence A) • The practices of combining or alternating paracetamol and ibuprofen have limited value and are not recommended. [15,16] (Evidence B) • Mefenamic acid is registered for use from 6 months of age and may be an alternative non-steroidal anti-inflammatory (NSAID) to ibuprofen in children with fever. The recommended dose is 6.5 mg/kg of body weight, not more than three times daily (Evidence B).…”

Automedicação Em Crianças Matriculadas Em Creche Pública

“…O risco de ocorrência de agranulocitose e anemia aplásica, relacionadas à dipirona, é uma questão amplamente discutida e pouco esclarecida (15) . O paracetamol é derivado do aminofenol, prescrito na dose de 10 a 15 mg/Kg, apresenta biotransformação hepática e risco de hepatotoxicidade, seu uso em crianças com menos de 2 anos de idade ou menos de 11 Kg requer orientação médica (16) . Neste estudo, embora ocorra baixa incidência de automedicação com ácido acetilsalicílico (AAS), esse AINE, utilizado principalmente como paliativo nos sintomas das doenças envolvendo vias respiratórias superiores, está estreitamente relacionado ao risco de Síndrome de Reye (4)(5)8,(15)(16) .…”

Fever in children: how to minimise risk and provide appropriate therapy

“…2,[5][6][7][8][9][10][11] The practice of combining or alternating paracetamol and ibuprofen has limited value and is not recommended. [12][13][14] Mefenamic acid is registered for use from six months of age, and may be an alternative nonsteroidal anti-inflammatory drug (NSAID) to ibuprofen in children with fever. The recommended dose is 6.5 mg/kg body weight, not more than three times daily.…”