Ibuprofen more effective than paracetamol in childhood fever
Children who are given ibuprofen for fever are apyrexial for longer than those given paracetamol during the first 24 hours of illness.
The single-blind study recruited 156 children aged six months to six years from primary care settings in Bristol. All participants had a fever between 37.8oC and 41oC presumed to be caused by a minor illness.
The children were randomised to receive either paracetamol every 4-6 hours (maximum of four doses in 24 hours), ibuprofen every 6-8 hours (maximum of three doses in 24 hours), or both. Parents were given treatment plans and the dose was based on the weight of the child. Temperature was monitored using continuous axillary monitoring and parents kept symptom diaries. The study team reviewed the children at 24 and 48 hours and at day five.
During the first four hours, children given the paracetamol/ibuprofen regimen or ibuprofen alone were on average free from fever for longer than those treated with paracetamol alone (average 55 minutes longer, P=<0.001, and 39 minutes longer, P=<0.001, respectively). After 24 hours, children in the combined treatment group were free from fever for 4.4 hours longer than those treated with paracetamol and 2.5 hours longer compared with children in the ibuprofen group. Unfortunately, the study size made it difficult to draw any firm conclusions about symptom control after 24 hours, although the odds ratios tended to favour ibuprofen.
An accompanying editorial1 states that this trial shows that ibuprofen is the most suitable drug to use for fever in children because of its longer action. It also warns that, because it is easy for parents to overdose their children (31 children received a drug overdose during this trial), a ‘more complicated alternating regimen of paracetamol and ibuprofen may be less safe than using either drug alone.'
NICE2 has advised that reducing fever in young children is not associated with shortening the duration of illness or reducing complications. However, we need to rule out conditions where intervention is required and to offer advice about measures to make the child more comfortable and parents less anxious.
I would use ibuprofen for fever in young children, unless the child is dehydrated, but would consider adding paracetamol during the first 24 hours when faced with anxious parents or other special factors.
Hay AD, Costelloe C, Redmond NM et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial. BMJ 2008;337:a1302Reviewer
Dr Peter Saul
GP, Wrexham and hospital practitioner in paediatrics (asthma and allergy)