Giving Ibuprofen Before Paracetamol Shortens Fever In Children

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Main Category: Pediatrics / Children's Health
Also Included In: Clinical Trials / Drug Trials
Article Date: 04 Sep 2008 - 0:00 PDT

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If given a regimen of ibuprofen followed by concurrent administration of ibuprofen and paracetamol, fever in young children may be controlled, according to a study released on September 3, 2008 in BMJ.

A common symptom of childhood illness, fever simply indicates a higher body temperature than normal. Most pre-school children are affected by fever in any given year. It is usually treated in the home and in the health-care office using either paracetamol or ibuprofen, but studies of the medications in combination must be further explored. The UK's National Institute for Health and Clinical Excellence indicated last year that, due to the lack of evidence regarding this use, these medications should not be combined or used in alternation.

To investigate the effects of various combinations of these treatments on children, scientists from the University of Bristol and the University of the West of England, identified 156 children at 35 primary care facilities in Bristol over the course of two years who were between the ages of 6 months and 6 years old, with temperatures between 100 and 106 degrees Fahrenheit (37.8 and 41 degrees Celsius, respectively,) raised due to an illness that could be treated at home. Each child was randomized to one of three groups: a combination of paracetamol and ibuprofen, paracetamol alone, or ibuprofen alone. Parents administered the treatments for up to 24 hours, with paracetamol every 4-6 hours and ibuprofen every 6-8 hours. The condition of each child was evaluated after 24 hours, 48 hours, and on the fifth day.

In examining each group of children, those in the combination treatment group had approximately 55 fewer minutes with fever in comparison with just paracetamol. However, the combination treatment did not show a significant advantage over the administration of just ibuprofen. In the first 24 hours, children in the combination group had 4.4 hours less fever time than those just given paracetamol, and 2.5 hours less than those given ibuprofen alone.

The researchers note that national guidelines that indicate extreme caution when using these drugs in combination should be reviewed, due to the potential positive effects of combination treatment. This includes the NICE guidelines. They further conclude: "Doctors, nurses, pharmacists and parents wanting to use medicines to treat young, unwell children with fever should be advised to use ibuprofen first and to consider the relative benefits and risks of using both medicines over a 24 hour period." Finally, the authors conclude that

Dr Anthony Harnden, of University of Oxford,  contributed an accompanying article pointing out that, by this trial, long action ibuprofen may be a good treatment for fever in these children. However, it may be unsafe because it is so easy to overdose the child -- this occurred in 31 of the test subject children. As a result, he advocates simplicity, as "more complicated alternating regimen of paracetamol and ibuprofen may be less safe than using either drug alone."

Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial
Alastair D Hay, Ceire Costelloe, Niamh M Redmond, Alan A Montgomery, Margaret Fletcher, Sandra Hollinghurst, Tim J Peters
BMJ 2008;337:a1302
doi:10.1136/bmj.a1302
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Written by Anna Sophia McKenney
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