Alternating ibuprofen and acetaminophen in the treatment of febrile children: a pilot study [ISRCTN30487061]

Nabulsi, Mona; Tamim, Hani; Mahfoud, Ziyad; Itani, Mohamad I.; Sabra, Ramzi; Chamseddine, Fadi; Mikati, Mohamad A.

doi:10.1186/1741-7015-4-4

Cited by 47 publications

(49 citation statements)

References 13 publications

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“…[71][72][73][74][75] Initially, changes in temperature were similar for all groups in these studies, regardless of therapy. However, 4 or more hours after the initiation of treatment, lower temperature was consistently observed in the combinationtreatment groups.…”

Section: Alternating or Combination Therapymentioning

confidence: 99%

“…For example, 6 and 8 hours after the initiation of the study, a greater percentage of children were afebrile in the combination group (83% and 81%, respectively) compared with those in the group that received ibuprofen alone (58% and 35%, respectively). 71 Only 1 study 72 evaluated issues related to stress and comfort and found lower stress scores and less time missed from child care in the combination-treatment group. Another study 73 showed a trend toward a normalization of fever-related symptoms by 24 and 48 hours after institution of therapy, but these trends disappeared by day 5.…”

Section: Alternating or Combination Therapymentioning

confidence: 99%

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Fever and Antipyretic Use in Children

Sullivan¹,

Farrar²

2011

Pediatrics

363

313

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Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a “normal” temperature. Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child's overall comfort rather than focus on the normalization of body temperature. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized. Current evidence suggests that there is no substantial difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever. There is evidence that combining these 2 products is more effective than the use of a single agent alone; however, there are concerns that combined treatment may be more complicated and contribute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices.

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Section: Alternating or Combination Therapymentioning

confidence: 99%

Section: Alternating or Combination Therapymentioning

confidence: 99%

Fever and Antipyretic Use in Children

Sullivan¹,

Farrar²

2011

Pediatrics

363

313

View full text Add to dashboard Cite

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“…The Israeli study 50 design appears to be difficult to interpret as half the children received both medicines in the first 24 hours and parents determined the timing of thermometry and distress scores. The Lebanese study 51 was probably accepted for publication as a pilot because of the large, statistically and clinically significant treatment effects in favour of combined treatment up to 4 hours post paracetamol dosing, but may be an example of publication bias. The American study found statistically but probably clinically unimportant temperature differences at 4 and 5 but not 6 hours when ibuprofen was added to paracetamol after 3 hours.…”

Section: Summary Of Limitations Of Previous Researchmentioning

confidence: 99%

“…51 All had rectal temperatures ≥ 38.8°C and the study aimed to assess the benefits of adding paracetamol (15 mg/ kg) or placebo 4 hours after a baseline dose of ibuprofen (10 mg/kg). The authors found that more children in the active group than in the placebo group (83% versus 58% respectively) were afebrile at 6 hours [number needed to treat (NNT) = 4], and that these effects persisted for up to 8 hours.…”

Section: Evidence For Using Paracetamol and Ibuprofen Togethermentioning

confidence: 99%

“…41 We searched Medline (1966 to March 2006), Cochrane and our own databases and found five published studies comparing paracetamol and ibuprofen in combination with single-agent paracetamol or ibuprofen. [48][49][50][51][52] The first studied 89 children hospitalised in India with axillary temperatures > 38.5°C. 48 Children received ibuprofen 10 mg/kg singly or in combination with paracetamol 10 mg/kg, each three times daily.…”

Section: Evidence For Using Paracetamol and Ibuprofen Togethermentioning

confidence: 99%

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Paracetamol and ibuprofen for the treatment of fever in children: the PITCH randomised controlled trial

Hay

Redmond²,

Costelloe³

et al. 2009

Health Technol Assess

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