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NICE childhood fever guidance set to change

By Nigel Praities

Giving feverish children the combination of ibuprofen and paracetamol is more cost-effective than either used singly, as well as being safe and more effective, according to a report which looks set to change NICE guidance.

Current NICE guidance prohibits the combination, but the new Health Technology Assessment has shown it to be preferable, as long as parents carefully monitor the doses they give.

The PITCH trial found children on the combined treatment had 55 minutes more time without fever in the first four hours than those on paracetamol and 17 minutes more than those given ibuprofen.

The clinical data was published in the BMJ last year but the HTA analysis found substantial cost-savings from using both treatments together, due to the lower use of health-care services.

Over the 5-day study period, paracetamol and ibuprofen together cost the NHS an average of £14 per patient, compared with £20 for paracetamol and £18 for ibuprofen.

The NICE guideline on feverish illness in children currently recommends GPs use either paracetamol or ibuprofen to reduce the temperature of children with fever, but not together.

Dr Alastair Hay, lead author of the study and a GP in Bristol, said GPs should still use ibuprofen first but recommended they tell parents to use ibuprofen plus paracetamol if a child remains unwell after the first dose.

‘The economic analysis shows that the use of both medicines should not be discouraged on the basis of cost to either parents or the NHS.

‘However, parents should keep a careful record of when doses are given to avoid accidentally giving too much,' he said.

Dr John Crimmins, a GP in Llantwit Major, Vale of Glamorgan, and a member of the guideline development group for the NICE feverish illness in children guideline, said the new evidence was welcome.

‘It is new evidence that was not available to us when we drew up the guideline. It does suggest it is helpful in terms of controlling temperature and the guidelines might have to be reviewed in that light. If it makes a child feel better its good,' he said.

But he added that the most important message from the guidance is that GPs should be encouraged to look for other features in feverish children indicating a sinister cause for the fever.

Childhood fever: guidance set to change after new findings Childhood fever: guidance set to change after new findings

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