Although the fear almost always is unwarranted, parents often are frightened by their children’s fevers. In this randomized, double-blinded study, researchers compared three common ways of lowering fever: acetaminophen (12.5 mg/kg) every 6 hours, ibuprofen (5 mg/kg) every 8 hours, and alternating doses of acetaminophen (12.5 mg/kg) and ibuprofen (5 mg/kg) every 4 hours. The study involved 464 Israeli children (age range, 6–36 months) with fevers of at least 38.4ºC. Each child received an initial loading dose of acetaminophen (25 mg/kg) or ibuprofen (10 mg/kg) and then received the assigned treatment for 3 days.
Compared with children who received monotherapy, those who received alternating doses of acetaminophen and ibuprofen had significantly lower fevers, lower levels of perceived stress, and fewer fever recurrences; they also missed significantly less time in day care and received less antipyretic medication overall. Loading doses had no effect on these outcomes, and no drug-related adverse events occurred.
Alternating acetaminophen with ibuprofen is common practice, but it has rarely been evaluated. Although the practice was effective in this study, many, if not most, current guidelines suggest monotherapy at higher doses (acetaminophen at 15 mg/kg every 4 hours, or ibuprofen at 10 mg/kg every 6 hours). I would be convinced to start using this study’s low-dose alternating regimen if additional studies found the regimen to be superior to standard higher-dose monotherapies.
Reference:
Sarrell EM et al. Antipyretic treatment in young children with fever: Acetaminophen, ibuprofen, or both alternating in a randomized, double-blind study. Arch Pediatr Adolesc Med 2006 Feb; 160:197-202.