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Guidelines published last year by the National
Institute for Health and Clinical Excellence (NICE) advise the use of either
medicine for children unwell or distressed with fever and state that, due to the
lack of evidence, they should not be combined or alternated.
A team of researchers from the University of Bristol and the University of the
West of England, recruited 156 children aged between six months and six years
old who had a temperature between 37.8 and 41 degrees centigrade, due to an
illness that could be managed at home. Children were randomised to receive
either paracetamol plus ibuprofen, just paracetamol, or just ibuprofen.
The children were recruited from 35 Bristol primary care sites during the two
year study.
The parents were advised to give the study medicines for up to 48 hours:
paracetamol every 4 to 6 hours (maximum of 4 doses in 24 hours) and ibuprofen
every 6 to 8 hours (maximum of 3 doses in 24 hours).
The children’s condition was followed up at 24 hours, 48 hours and at day five.
The researchers found that in the first four hours children given both medicines
spent an extra 55 minutes less time with fever compared to those given
paracetamol alone. But giving two medicines was not markedly better than just
giving ibuprofen.
However, over a 24 hour period, children given both medicines experienced 4.4
hours less time with fever than those given just paracetamol, and 2.5 hours less
time with fever than those just given ibuprofen.
The researchers say: “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.”
They conclude that the NICE guidance regarding the use of two medicines combined
does not need to be so cautious now that there is good evidence of superiority
for two drugs over one for increasing time without fever over 24 hours.
In an accompanying editorial, Dr Anthony Harnden from the University of Oxford,
says that this trial shows that longer action ibuprofen is the most suitable
drug to use for fever in children. He warns that because it is easy for parents
to overdose their children [31 children received a drug overdose in this trial],
a “more complicated alternating regimen of paracetamol and ibuprofen may be less
safe than using either drug alone.”
Contacts:
Dr Alastair Hay, NIHR National School for Primary Care Research, University of
Bristol.
Via Caroline Clancy, University of Bristol Press Office.
Tel: +44 (0) 117 331 8092 or +44 (0)7776 170 238 (out of hours mobile)
Editorial: Dr Anthony Harnden, Department of Primary Health Care, University Of
Oxford, Oxford, UK.
Via Rachael Davies, BMJ Press Office, London, UK.
Tel: +44 (0) 207 383 6529
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