Alternating and combined antipyretics effective for febrile children

Clinical question: 
How effective are alternating and combined paracetamol and ibuprofen for treating fever in children (aged 6 to 14 years)?
Bottom line: 
Compared with giving ibuprofen or paracetamol alone, giving both medications together was more effective at lowering temperature for the first 4 hours after treatment, but did not reduce discomfort or distress. Giving a single agent and then a further dose of the alternative was more effective at lowering temperature for the first 3 hours after the second dose, and reduced discomfort. Only 1 small trial compared alternating therapy with combined therapy and found no advantage with either. There were no serious adverse events directly attributed to the medications.
Caveat: 
There were only 6 studies included in the review. The levels of evidence were of moderate quality in 2 studies and of low quality in the other 4 studies. There was a large amount of variation between the trials in medication dosage, regimens of administration and frequency and type of assessment
Context: 
Health professionals frequently recommend fever treatment regimens that either combine or alternate paracetamol with other treatments
Review CD#: 
CD009572
PEARLS No: 
423
Date: 
February, 2014
Authored by: 
Brian R McAvoy