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.
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
Health professionals frequently recommend fever treatment regimens that either combine or alternate paracetamol with other treatments
Review CD#: 
February, 2014
Authored by: 
Brian R McAvoy