Major Finding: Six hours after administration, 50% of children treated with ibuprofen alone were febrile versus all but one child treated with combined or alternating doses of ibuprofen and acetaminophen.
Data Source: Randomized trial in 60 febrile children.
Disclosures: The research was supported by grants from the George L. Laverty Foundation, the National Institutes of Health, and the Penn State General Clinical Research Center. Dr. Paul disclosed serving as a consultant for Novartis, Procter & Gamble, and the Consumer Healthcare Products Association. Dr. Sekhar reported no conflicts.
VANCOUVER, B.C. — Combined and alternating doses of ibuprofen and acetaminophen provided greater antipyresis than ibuprofen alone in a randomized trial involving 60 febrile children.
Although combining and alternating doses of these agents is common, there are limited data to support this practice with standard U.S. doses.
In 2001 the American Academy of Pediatrics stated that “alternating doses every 6 hours might be used so that one drug or the other is administered every 3 hours,” but urged clinicians to “exercise discretion when considering this therapy” (Pediatrics 2001;108:1020–4). The current study evenly randomized children, aged 6 months to 7 years (mean, 3.4 years), with temporal artery temperatures of at least 38° C (mean, 38.7°) to ibuprofen alone, ibuprofen combined with acetaminophen, or ibuprofen followed by acetaminophen 3 hours later. Ibuprofen was dosed at 10 mg/kg and acetaminophen at 15 mg/kg.
At baseline, there was no significant difference in the children's temperatures, but at hour 4 there was a statistically significant increase in the ibuprofen-alone group that was maintained at hours 5 and 6, Dr. Deepa Sekhar reported on behalf of principal investigator Dr. Ian M. Paul and their colleagues at Pennsylvania State University in Hershey.
At hour 6, 50% of the ibuprofen-alone children were febrile (mean, 38.5° C), whereas in both of the combined groups, all of the children were afebrile, except one in the ibuprofen plus acetaminophen group.
The findings at hours 4, 5, and 6 for the combined arm are highly relevant to parents who give medications to their children prior to day care, school, or sleep, Dr. Sekhar said at the meeting.
“Right or wrong, fever phobia is widespread among parents and caregivers alike,” she commented.
One attendee questioned whether using two medications reinforces this phobia. Dr. Sekhar agreed, but said that many parents she sees are already using two and that now she can tell them these regimens work and are safe.
The regimen of ibuprofen followed by acetaminophen 3 hours later was chosen because health care providers tend to prefer ibuprofen first for higher fevers, Dr. Paul said in an interview.
A previous survey of 161 pediatric providers found that 50% advise parents to alternate acetaminophen and ibuprofen for febrile illnesses, and that 57% use ibuprofen for temperatures of 102° F or higher (Pediatrics 2000;105:1009–12).
Another attendee questioned whether fever should be fought as it is, observing that several infectious disease colleagues favor fever and feel it is associated with a number of immunologic changes that could be beneficial for fighting infection.
Again Dr. Chakar agreed, and to a round of laughter added, “But school nurses are powerful people.”
Dr. Paul told this news organization: “Day cares and schools are more concerned with a number on the thermometer rather than what should or shouldn't be fought or even the activity/functioning of the child. They have firm rules as to who gets sent home and who doesn't based on this number. This has a trickle-down effect to parents and health care providers.”