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Acetaminophen, Ibuprofen, or Both Alternating in a Randomized, Double-blind Study

E. Michael Sarrell, MD; Eliahu Wielunsky, MD; Herman Avner Cohen, MD

Arch Pediatr Adolesc Med. 2006;160:197-202.

Objective  To compare the antipyretic benefit of acetaminophen or ibuprofen monotherapy with an alternating regimen of both drugs in young children aged 6 to 36 months.

Design  Randomized, double-blind, parallel-group trial.

Setting  Three primary pediatric community ambulatory centers in central Israel.

Participants  A total of 464 children aged 6 to 36 months with fever.

Intervention  Infants were assigned to receive either acetaminophen (12.5 mg/kg per dose every 6 hours) (n = 154) or ibuprofen (5 mg/kg per dose every 8 hours) (n = 155) or to receive alternating acetaminophen and ibuprofen (every 4 hours) (n = 155) for 3 days after a loading dose.

Main Outcome Measures  Temperature, stress score, amount of antipyretic received, total days that the infant or caregiver was absent from day care or work, respectively, at the 3-day time point, recurrence of fever, and number of emergency department visits.

Results  The group given the alternating regimen was characterized by a lower mean temperature, more rapid reduction of fever, receiving less antipyretic medication, less stress, and less absenteeism from day care as compared with the other groups; all of the differences were statistically significant (P<.001). None of the regimens were associated with a significantly higher number of emergency department visits (P = .65) or serious long-term complications (P = .66). The drug used for initial loading had no effect on outcome in any of the groups.

Conclusions  An alternating treatment regimen of acetaminophen (12.5 mg/kg per dose) and ibuprofen (5 mg/kg per dose) every 4 hours for 3 days, regardless of the initial loading medication, is more effective than monotherapy in lowering fever in infants and children.

Author Affiliations: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Drs Sarrell, Wielunsky, and Cohen); and Pediatric Ambulatory Center General Health Services (Drs Sarrell and Cohen) and Schneider Children's Medical Center of Israel (Dr Wielunsky), Petah Tiqva, Israel.

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