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Editorials

Antipyretic drugs for children

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7557.4 (Published 29 June 2006) Cite this as: BMJ 2006;333:4
  1. Alastair D Hay (alastair.hay@bristol.ac.uk), consultant senior lecturer in primary health care,
  2. Niamh Redmond, trial coordinator,
  3. Margaret Fletcher, reader in children's nursing
  1. Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol BS6 6JL
  2. Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol BS6 6JL
  3. Faculty of Health and Social Care, University of the West of England Bristol, Stapleton, Bristol BS16 1DD

    There's still not enough evidence to support prescribing paracetamol and ibuprofen in combination or alternately

    Fever is common in children1 and can cause distress, parental anxiety, and—in some parents—“fever phobia.”2 Rationales for treating childhood fever include relieving distress (allowing the child to sleep, rest, or feed) and lowering temperature, often in the hope of reducing the risk of febrile convulsions. Non-pharmacological treatments include loosening clothing, reducing the ambient temperature, and encouraging the child to take fluids. The pharmacological options are paracetamol and ibuprofen, and parents commonly give both drugs to a child with fever.3 But should these drugs be used together, or alternately, and for which children, and at what dose and frequency? Advice is inconsistent, leading to confusion and frustration among parents, nurses, and doctors.

    Both drugs are licensed and widely purchased over the counter in Europe for children: sales in 2004 were £128m for paediatric ibuprofen and £277m for paracetamol (€186m and €403m, $233m and $504m; personal communication, Boots Healthcare International). Paracetamol and ibuprofen exert their effects at differing points in the pyrogenic pathways,4 so synergistic action is plausible.

    We searched Medline (1966 to March 2006), the Cochrane …

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