Acetaminophen with ibuprofen therapy effective in febrile children: Study

A new study published in the journal of Pediatrics showed that when treating children with fever, combination therapy may be more effective than monotherapy. Since fever is a common early clinical sign of acute infections, it has long been a symptom of great worry to parents and clinicians. Parents frequently experience worry and anxiety when their child has refractory fever, which is characterized by a poor response to an antipyretic medication or a fever return prior to the next pharmacological dose.

Despite worries about possible medication toxicity and negative interactions, children with refractory fever have been treated in practice using a regimen of alternating acetaminophen and ibuprofen at various doses and intervals. Also, the safety of alternating antipyretic treatment has not yet been shown, and the risk of improper and excessive administration is increased by the probability that parents may not comprehend dosage recommendations. It is unclear if the effects and safety of acetaminophen and ibuprofen as single or dual (alternating or combination) therapy are comparable. Thus, using a systematic review and network meta-analysis, Juan and his colleagues carried out this study to evaluate the relative effectiveness of acetaminophen, ibuprofen alone, alternating, or in combination.

From the beginning until September 20, 2023, Embase, Medline and CENTRAL were examined for this investigation. Randomized studies comparing the use of acetaminophen, ibuprofen, both alternating and both combined, to treat fever in children were carefully validated. The study used the random-effects model for both pairwise and network meta-analysis.

There were 31 trials (5009 children) in this research. In terms of the percentage of afebrile children in the 4th hour, this study discovered that ibuprofen at a high dose may be equivalent to acetaminophen (OR, 0.98; CI, 0.63–1.59), while combined and alternating therapy (OR, 0.20; CI, 0.06–0.63) may be preferable. At the 6th hour, these outcomes were comparable. Regarding adverse events, there were no differences between ibuprofen (low or high dosage), alternating, or coupled with acetaminophen.

When it came to managing fever in children, dual therapy could be better than solo ones. And in the case of treating afebrile kids between four and six hours, acetaminophen might not be as effective as alternate or combination therapy. Acetaminophen performed similarly to ibuprofen at 6 hours but worse than ibuprofen alone at 4 hours.

Reference:

De la Cruz-Mena, J. E., Veroniki, A.-A., Acosta-Reyes, J., Estupiñán-Bohorquez, A., Ibarra, J. A., Pana, M. C., Sierra, J. M., & Florez, I. D. (2024). Short-term Dual Therapy or Mono Therapy With Acetaminophen and Ibuprofen for Fever: A Network Meta-Analysis. In Pediatrics (Vol. 154, Issue 4). American Academy of Pediatrics (AAP). https://doi.org/10.1542/peds.2023-065390