Alternating Acetaminophen with Ibuprofen for Fever: Is this a Problem?

Miller, Alvin A.

doi:10.3928/0090-4481-20070701-05

“…O temor dos pais em participar de um estudo para tratamento de febre faz com que seja difícil randomizar o número necessário de pacientes para responder a questão clínica 5,33 . Os motivos são inúmeros, advindos principalmente do desconhecimento sobre o processo febril 4,34 .…”

Section: Discussionunclassified

Alternating antipyretics in the treatment of fever in children: a systematic review of randomized clinical trials

Pereira¹,

Dagostini²,

Pizzol³

2012

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Objective: To summarize the existing evidence on the efficacy of therapy with alternating antipyretics compared to monotherapy in the management of fever in children.Sources: MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, IBECS, Web of Science, Clinical Trials, Google Scholar and references of the articles found. The review included randomized clinical trials published until December 2011, in which one of the arms was the alternating antipyretics therapy to treat fever in children younger than 12 years, treated on an outpatient basis. Data selection and extraction were performed independently by two reviewers. The quality of the studies was assessed according to CONSORT items. Summary of the findings:The selected studies showed great heterogeneity of participants, temperature for fever diagnosis, interventions (dose and dosing intervals) and assessed outcomes. The treatment groups ranged from 38 to 464 children. The studies compared paracetamol and ibuprofen alternated with paracetamol and/or ibuprofen. Only one study used different doses from the 15 mg/kg for paracetamol and 10 mg/kg for ibuprofen, but the dosing intervals varied considerably. The alternate use with dipyrone or acetylsalicylic acid was not assessed by any of the studies. Overall, the articles pointed to a tendency of lower mean temperatures in groups with alternating therapy. Few adverse effects were reported. Conclusion:Although there was a tendency towards the reduction of mean temperatures with alternating antipyretics compared to the use of one antipyretic alone, there is not enough evidence to say that alternating antipyretic therapy is more effective than monotherapy.J Pediatr (Rio J), 2012;88(4):289-96: Fever, children, antipyretics, efficacy, alternating therapy, review. ResumoObjetivo: Sumarizar as evidências existentes sobre a eficácia da terapia alternada com antipiréticos no manejo da febre em crianças comparada com monoterapia.Fontes de dados: MEDLINE, EMBASE, Cochrane Library, LILACS, SciELO, IBECS, Web of Science, Clinical Trials, Google Scholar e referências dos artigos encontrados. Foram incluídos na revisão ensaios clínicos randomizados, publicados até dezembro de 2011, em que um dos braços fosse terapia alternada com antipiréticos para tratamento de febre em crianças menores de 12 anos, atendidas em nível ambulatorial. A seleção e extração dos dados foram realizadas independentemente por dois revisores. A qualidade dos estudos foi avaliada de acordo com os itens do CONSORT. Síntese dos dados:Os estudos selecionados apresentaram grande heterogeneidade em relação aos participantes, temperatura para diagnóstico de febre, intervenções (doses e intervalos entre doses) e desfechos avaliados. Os grupos de tratamento variaram de 38 a 464 crianças. Os estudos compararam paracetamol e ibuprofeno alternados com paracetamol e/ou ibuprofeno. Em apenas um estudo foram utilizadas doses diferentes de 15 mg/kg para paracetamol e 10 mg/kg para ibuprofeno, mas os intervalos entre doses variaram consideravelmente. Em nenhum estudo fo...

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“…Essa alternância é apoiada por Mayoral et al 28 e pela metanálise de Sarrel et al 29 , os quais preconizam que, em fase inicial das doenças que frequentemente acometem as crianças que procuram os serviços de emergência, os antitérmicos sejam administrados a cada 4 horas, e consideraram que essa conduta não gera efeitos adversos, embora deva ser realizada com supervisão médica para que se evite superdosagem 6,30 .…”

Section: Discussionunclassified

Antipyretic effect of ibuprofen and dipyrone in febrile children

Magni¹,

Scheffer²,

Bruniera³

2011

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Objective: To evaluate temperature changes in febrile children that received a single oral dose of ibuprofen (10 mg/kg), the dose recommended for high fever, or dipyrone (15 mg/kg), the dose recommended by the manufacturer, at 2, 3, 4, 5, 6, 7 and 8 hours after administration.Methods: This open-label randomized (1:1) controlled clinical tried enrolled 80 febrile boys and girls aged 6 months to 8 years with baseline axillary temperatures of 38.0 to 40.3 °C. The children were divided into two groups: high fever (> 39.1 °C) and low-grade fever (38.0 to 39.1 °C). The antipyretic effect was analyzed according to discontinuity, safety, response to treatment, tolerability and therapeutic efficacy. Results:Of the 80 children, 31 remained febrile during the 8 hours (38.8%), but 100% had a temperature decrease in the first 2 hours after the administration of either medication. In the high fever group, the temperature fell in 11 children treated with ibuprofen up to the 5th hour (100.00%) and in the 11 that received dipyrone, up to the third hour (100.00%). The difference in antipyretic efficacy of ibuprofen in the high fever group was statistically significant in the 3rd and 4th hours, and in the low-grade fever group, in the 3rd hour after medication. Conclusions:A single oral dose of ibuprofen has a greater antipyretic efficacy than dipyrone, particularly when the fever is high. Both drugs were well tolerated and safe in the short term.J Pediatr (Rio J). 2011;87(1):36-42: Fever, ibuprofen, dipyrone, nonsteroidal anti-inflammatory drugs, children. ResumoObjetivo: Analisar o comportamento da temperatura em crianças febris medicadas com dose oral única do ibuprofeno (10 mg/kg), dose recomendada para febre alta, comparado à dipirona (15 mg/kg), dose preconizada pelo fabricante, após 2, 3, 4, 5, 6, 7 e 8 horas da medicação antitérmica.Métodos: Ensaio clínico, aberto e randomizado (1:1), em crianças de ambos os sexos, com doenças febris, com idade entre 6 meses e 8 anos, temperatura axilar basal entre 38,0 e 40,3 °C, e divididas em dois grupos: febre alta (> 39,1 °C) e febre baixa (38,0 a 39,1 °C). A análise do comportamento baseou-se nos critérios de descontinuidade, segurança, resposta ao tratamento, tolerabilidade e eficácia terapêutica.Resultados: Das 80 crianças, 31 permaneceram afebris ao longo de 8 horas (38,8%), 100,0% obtiveram decréscimo da temperatura com ambas as medicações nas 2 primeiras horas. No grupo de febre alta, 11 crianças medicadas com ibuprofeno foram mantidas até a 5ª hora (100,0%), e 11 com dipirona até a 3ª hora (100,0%). A eficácia antipirética na febre alta foi estatisticamente significante a favor do ibuprofeno na 3ª e na 4ª hora, e, na febre baixa, na 3ª hora após a medicação. Conclusões:Este estudo demonstrou que, em dose oral única, o ibuprofeno proporciona atividade antipirética mais acentuada do que a dipirona, principalmente na febre alta. Ambas as medicações foram bem toleradas e seguras em curto prazo.J Pediatr (Rio J). 2011;87(1):36-42: Febre, ibuprofeno, dipirona, anti-inflamatór...

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“…Alternate use is supported by Mayoral et al 28 and by the results of the metaanalysis conducted by Sarrel et al, 29 who recommended that, in the initial phase of the diseases that often affect children seen in emergency departments, antipyretic drugs should be administered every 4 hours, a procedure that has no adverse effects but that should be performed under medical supervision to avoid overdoses. 6,30 This study analyzed the antipyretic effect of ibuprofen and dipyrone in febrile children and found that a single oral dose of ibuprofen has a better antipyretic effect than a single oral dose of dipyrone, particularly in cases of high fever. Both drugs were well tolerated and safe in the short term.…”

Section: Discussionmentioning

confidence: 99%

Comportamento dos antitérmicos ibuprofeno e dipirona em crianças febris

Magni¹,

Scheffer²,

Bruniera³

2011

J. Pediatr. (Rio J.)

5

0

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Objective: To evaluate temperature changes in febrile children that received a single oral dose of ibuprofen (10 mg/kg), the dose recommended for high fever, or dipyrone (15 mg/kg), the dose recommended by the manufacturer, at 2, 3, 4, 5, 6, 7 and 8 hours after administration. Methods:This open-label randomized (1:1) controlled clinical tried enrolled 80 febrile boys and girls aged 6 months to 8 years with baseline axillary temperatures of 38.0 to 40.3 °C. The children were divided into two groups: high fever (> 39.1 °C) and low-grade fever (38.0 to 39.1 °C). The antipyretic effect was analyzed according to discontinuity, safety, response to treatment, tolerability and therapeutic efficacy. Results:Of the 80 children, 31 remained febrile during the 8 hours (38.8%), but 100% had a temperature decrease in the first 2 hours after the administration of either medication. In the high fever group, the temperature fell in 11 children treated with ibuprofen up to the 5th hour (100.00%) and in the 11 that received dipyrone, up to the third hour (100.00%). The difference in antipyretic efficacy of ibuprofen in the high fever group was statistically significant in the 3rd and 4th hours, and in the low-grade fever group, in the 3rd hour after medication. Conclusions:A single oral dose of ibuprofen has a greater antipyretic efficacy than dipyrone, particularly when the fever is high. Both drugs were well tolerated and safe in the short term. This study received a grant from the research fund sponsored by Janssen Cilag Farmacêutica. Financial support: Janssen Cilag Farmacêutica.Suggested citation: Magni AM, Scheffer DK, Bruniera P. Antipyretic effect of ibuprofen and dipyrone in febrile children.

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Alternating Acetaminophen with Ibuprofen for Fever: Is this a Problem?

Cited by 5 publications

References 22 publications

Alternating antipyretics in the treatment of fever in children: a systematic review of randomized clinical trials

Alternating antipyretics in the treatment of fever in children: a systematic review of randomized clinical trials

Antipyretic effect of ibuprofen and dipyrone in febrile children

Comportamento dos antitérmicos ibuprofeno e dipirona em crianças febris

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