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Ibuprofen plus paracetamol best for febrile children

Ibuprofen and paracetamol together are better than either painkiller alone for easing fever in pre-school children, a new study concludes.

The double-blind, controlled trial also found ibuprofen alone was better than paracetamol for reducing temperature.

The research is set to help clarify practice in the area, with NICE currently advising that either drug is appropriate for febrile children, but that they should not be administered simultaneously.

University of Bristol researchers looked at 156 children aged six months to six years presenting with temperatures between 37.8°C and 41°C. Their study, presented at the North American Primary Care Research Group annual meeting in Vancouver, Canada, found combining antipyretics reduced fever duration in the first four hours and first day of treatment compared with monotherapy.

In the first 24 hours, combined treatment resulted in 263 minutes less fever than paracetamol and 152 minutes less than ibuprofen.

Those on combined treatment had 55 minutes less fever in the first four hours than those given paracetamol and 17 minutes less than those given ibuprofen.

Study leader Dr Alastair Hay, senior lecturer in primary care at the University of Bristol, said: ‘Combined treatment is better than paracetamol use and may also be better than single-agent ibuprofen.'

Dr Anthony Harnden, lecturer in primary health care at the University of Oxford and RCGP spokesman, said the findings were ‘interesting' and could have practical implications for GPs.

‘The results suggest ibuprofen is better at reducing the duration of fever than paracetamol and a combination of the two better still.

‘What is disappointing is neither drug or combination appeared to be more beneficial at reducing discomfort. It is the discomfort rather than the antipyretic effect per se that is clinically important.'

Dr Brian Crichton, a GP in Solihull, Birmingham, and honorary lecturer in therapeutics and pharmacology at the University of Warwick, said: ‘There hasn't been an evidence base behind it but GPs do use the combination especially in more complicated cases. From a mechanistic point of view, paracetamol works more centrally while ibuprofen works more peripherally so the two are working at different sites.'

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