Combined and alternating paracetamol and ibuprofen therapy for febrile children

Wong, Tiffany; Stang, Antonia; Ganshorn, Heather; Hartling, Lisa; Maconochie, Ian; Thomsen, Anna M; Johnson, David W.

doi:10.1002/ebch.1978

Cited by 40 publications

(44 citation statements)

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“…This needs to be reviewed carefully as data on safety and efficacy of alternating combined therapy in children with pain is lacking [28,30]. A systematic review concluded that the safety and efficacy of the combination of ibuprofen and paracetamol in fever remains obscure [31] and there may be an additional risk for medication errors [32].…”

Section: Discussionmentioning

confidence: 99%

“…Paediatric studies on newer, medium potent opioids such as tapentadol are ongoing within the frame of a paediatric investigation plan (PIP) and results may become available in the near future [39,40]. Also more data regarding the benefits and risks of paracetamol, ibuprofen and its combinations became available and may influence practice [31]. Therefore, our data form an excellent basis to evaluate the impact of these latest regulatory developments and to compare the effectiveness of changes in guidelines and recommendations.…”

Section: Discussionmentioning

confidence: 99%

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Analgesic Drug Prescription Patterns on Five International Paediatric Wards

et al. 2016

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Key points• Use of analgesic and anti-inflammatory drugs was in line with local recommendations and WHO guidelines • Oral paracetamol and oral ibuprofen are the most commonly used analgesic drugs on general paediatric wards • Differences regarding dose and frequency of ibuprofen and paracetamol use were observed, indicating that safety concerns for individual drugs are perceived differently among countries BOTZENHARDT et al. 2/1 2016-09-16 ABSTRACT AimAnalgesic and anti-inflammatory drugs are frequently prescribed in paediatrics. Prescribing and dosing patterns in hospitalised children are not well known. This study explores analgesic drug utilisation on five paediatric wards and discusses its findings in comparison with WHO guidelines. MethodA sub-analysis of a prospective, multi-centre, observational cohort study was undertaken. Prescription data of children aged up to ≤18 years were collected between October 2008 and December 2009 on paediatric general medical wards in five hospitals in Australia, Germany, the United Kingdom (UK), Hong Kong (HK) and Malaysia. Analgesic drug prescriptions were analysed for prescribing patterns in terms of dosing, frequency and route of administration. Dosing data were compared with local recommendations and WHO guidelines for children. ResultsIn the study cohort 56.8% (726/1,278) of paediatric patients received at least one analgesic drug prescription (1,227 prescriptions). Median age of patients with analgesics was 2.2 years (IQR 0.8-7.3) and median number of prescriptions per patient was 1 (IQR 1-2). Most commonly prescribed drugs were oral paracetamol (45.9%, 563/1,227) and oral ibuprofen (19.9%, 244/1,227). Daily doses of paracetamol ranged from 30 mg/kg/day in Germany to 67-68 mg/kg/day in UK and HK (p<0.05). For ibuprofen, single doses ranged from 5-6 mg/kg in HK and UK to 10 mg/kg in GER and AUS (p<0.001). Opioid use prevalence was statistically different between the centres and ranged from 0% to 17.6% (p<0.001). ConclusionThis study provides a comprehensive overview of analgesic drug use of hospitalised children. Similar to primary care data, paracetamol is the most commonly used analgesic. As recommended by WHO guidelines, oral medication was favoured and opioids used in addition to paracetamol and ibuprofen. Overall drug utilisation was in line with local recommendations and WHO guidelines. Differences in use of paracetamol and ibuprofen among countries was seen indicating that safety concerns are perceived differently. More large-scale safety studies are needed. BOTZENHARDT et al.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analgesic Drug Prescription Patterns on Five International Paediatric Wards

et al. 2016

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“…In study by Kokki the effect of antipyretic paracetamol, ibuprofen and ketoprofen were compared with each other to reduce the child's temperature and showed that ketoprofen in the symptomatic treatment of fever in children is more effective than other drugs [18]. Wong concluded that the combination therapy compared to alternative antipyretic was more effective in reducing the temperature [19]. In a study by Smith observed that, despite of acetaminophen and ibuprofen alternative therapies for the treatment of pain in children, there is no evidence of the appropriateness and effectiveness of treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Acetaminophen Plus Ibuprofen to Treat Fever Than any of the Two Alone in Febrile Children

Noori

Miri‐Aliabad

Boryri

et al. 2016

Zahedan J Res Med Sci

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Background: Fever is a natural response of the host to infection and a normal part of children's infectious disease. Objectives: The purpose of the study was comparison of the combined treatment of acetaminophen and ibuprofen compact with each treatment alone. Methods: This Double-blind clinical trial study was done on 540 children with 38°C to 41°C as body temperature. Eligible children after considering inclusion criteria divided in three groups randomly. First group of 183 patients administrated with acetaminophen, the second and the third groups of 178 and 179 patients with ibuprofen and combination. The first dose of antipyretic drug was administered to the patient under the supervision of a physician or nurse. After explanation of benefits and marginal effects to the parents if they accepted the conditions their children were admitted to the study. Parents were free if they wish to withdraw the study before completing. Information of each patient was recorded on a form. The data were analyzed by descriptive statistic, one-way ANOVA and SPSS software version 16. Results: Out of sample 60.6% were boy. The mean age of children treated with acetaminophen, ibuprofen and combination therapy

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“…To date, there is limited but promising evidence to support the practice of combining acetaminophen and ibuprofen for pain treatment in children. [20][21][22][23][24] As noted by others, there remains a need for large-scale studies on both the efficacy and safety of this combination for the treatment of pain. 20 When asked to choose their preferred oral analgesic, respondents showed a strong preference for ibuprofen over acetaminophen.…”

Section: Discussionmentioning

confidence: 99%

Analgesia for acute gingivostomatitis: a national survey of pediatric emergency physicians

MacLellan

Ali

Curtis

et al. 2016

CJEM

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Objectives: Gingivostomatitis is a common, painful pediatric presentation, and yet, few studies are available to guide management. We aimed to describe pediatric emergency physicians' current practice patterns, with respect to analgesic use in children with acute gingivostomatitis, in order to inform future studies. Methods: A national survey was conducted at all 15 national academic pediatric centres.Electronic surveys were distributed to pediatric emergency physicians using a modified Dillman protocol; non-respondents received paper surveys via post. Data were collected regarding demographic characteristics, clinical behaviour, factors that may influence practice, and future directions. Results: Response rate was 74% (150/202). Most physicians (72%) preferred the combination of acetaminophen and ibuprofen to either agent alone (ibuprofen 19%, acetaminophen 7%). The preferred second-line analgesics were oral morphine (48%, 72/150) and compounded topical formulas (42%, 64/150). The most commonly cited compounded agent was Benadryl plus Maalox (23%, 35/150). Clinical experience with a medication had the greatest influence on practice pattern, with 52% (78/149) strongly agreeing. The most commonly cited barrier to adequate analgesia was difficulty in the administration of topical or oral medication to children. Conclusions: As with many other painful conditions, the combination of acetaminophen and ibuprofen was preferred, followed by either agent alone. Oral morphine and topical compounded agents were also frequently prescribed. Regardless of patient age, physicians preferred oral morphine as a secondline agent to treat pain from severe gingivostomatitis. Future research will focus on determining which analgesic and route (oral or topical) is the most effective and best-tolerated choice. . Le facteur qui influait le plus sur la pratique était l'expérience clinique d'un médicament; en effet, 52% (78/149) des participants se sont dits « tout à fait d'accord » sur l'énoncé. Enfin, le plus grand obstacle à une analgésie suffisante était la difficulté d'administration des médicaments topiques ou oraux aux enfants. Conclusions: Comme dans bien d'autres affections douloureuses, l'association d'acétaminophène et d'ibuprofène était la formule préférée, suivie de l'utilisation seule de l'un ou l'autre de ces médicaments. Étaient souvent prescrits aussi la morphine par voie orale et les composés topiques. Indépen-damment de l'âge, les médecins préféraient la morphine par voie orale comme médicament de deuxième intention pour traiter la douleur causée par une gingivostomatite importante. Enfin, les futurs travaux de recherche devraient porter sur l'analgésique le plus efficace et la meilleure voie d'administration (orale ou topique) ainsi que sur la formule la mieux tolérée.

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Combined and alternating paracetamol and ibuprofen therapy for febrile children

Cited by 40 publications

References 43 publications

Analgesic Drug Prescription Patterns on Five International Paediatric Wards

Analgesic Drug Prescription Patterns on Five International Paediatric Wards

Comparison of the Effects of Acetaminophen Plus Ibuprofen to Treat Fever Than any of the Two Alone in Febrile Children

Analgesia for acute gingivostomatitis: a national survey of pediatric emergency physicians

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