Ibuprofen lowers fever faster than acetaminophen
Fever is a common side effect of common infections in children. Whether it should always be medicated, or perhaps viewed as part of the body's natural immune response, is controversial. However, once the decision for antipyretic therapy has been made, a faster onset of action is usually desired. The most common antipyretic drugs used in pediatrics are paracetamol and ibuprofen. Since they have a different mechanism of action, an additive effect is conceivable. For fear of overdosing, combinations have generally been discouraged, especially since paracetamol has a narrow therapeutic range.
The English study included 156 children between the ages of six months and six years who were acutely ill with a fever between 37.8 and 41 ° Celsius and were treated at home. The children were randomized to three groups in which they received either paracetamol or ibuprofen or a combination of both. The dose used was determined according to the weight of the child: one dose of paracetamol corresponded to 15 mg / kg body weight, one dose of ibuprofen corresponded to 10 mg / kg body weight. The primary study goal was the fever-free time in the first five hours after the first medication.
The fastest - after an average of 42.2 minutes - the children who took ibuprofen reached a temperature below 37.2 ° C and were therefore considered to be free of fever. It took a little longer - 45.5 minutes on average - under the combination, while the children under paracetamol monotherapy were free of fever after an average of 71 minutes. As a conclusion from these results, the authors recommend that ibuprofen be used first if a rapid reduction in fever is desired.
If ibuprofen alone was superior to the other two therapies in the first four hours, the effect apparently wears off afterwards - despite repeated administration. In the study, the children were free of fever 2.5 hours longer in the first 24 hours on a combination of paracetamol and ibuprofen than on ibuprofen alone.
Pragmatic recommendation from the authors
For pragmatic reasons, the authors draw a daring conclusion: Although this option was not investigated in the study, ibuprofen and paracetamol should be used alternately in order to keep the children free of fever for as long as possible in the first 24 hours. It is important that parents carefully note when they give which doses. This is to avoid accidental overdosing. However, this recommendation is in contrast to the current recommendations of the National Institute for Health and Clinical Excellence (NICE), which advises doctors to choose between ibuprofen or paracetamol, but not to combine both drugs. However, the authors of the study are convinced that alternating dosing is not only better, but also cheaper. To prove this, a cost-benefit analysis should be carried out.
Hay, A .; et. al .: Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomized controlled trial. Brit. Med. J. 2008; 337; a1 302. Doi: 10.1136 / bmj.a1302).
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