A5V4d

ibuprofen compared with paracetamol and ibuprofen combined
ibuprofen compared with paracetamol and ibuprofen alternating
Antipyretic interventions
paracetamol and ibuprofen combined compared with paracetamol and ibuprofen
alternating.
Description of included studies
Twenty-five studies were included in this review (Gupta et al., 2007; Walson et al., 1989; Kauffman et
al., 1992; Wilson et al., 1991; Brewer et al., 1968; Autret et al., 1997; Nadal et al., 2002; Sarrell et al.,
2006; Wong et al., 2001; Erlewyn-Lajeunesse et al., 2006; Sidler et al., 1990; Ulukol et al., 1999;
Autret et al., 1994; McIntyre et al., 1996; Vauzelle-Kervrodan et al., 1997; Van Esch et al., 1995;
Autret-Leca et al., 2007; Southey et al., 2009; Beasley et al., 2008; Pierce et al., 2010;Hay et al.,
2009; Pashapour et al., 2009; Kramer et al., 2008; Paul et al., 2010; Nabulsi et al., 2006). No studies
were identified comparing alternating or combining antipyretics with placebo.
All the identified studies were RCTs, meta-analyses of RCTs or large case series. Studies were
mainly undertaken in Europe and North America. Study dates ranged from the 1980s to 2010.
Assessment of effectiveness was hampered by the heterogeneity of study protocols, with different
entry criteria, outcomes, measurement times and dosages of drugs being used. As a result of this
heterogeneity, a meta-analysis was not undertaken.
A number of calculations have been used in this review. For a relative risk, an effect size of 0.25 with
the 95% confidence interval (CI) not crossing 1 (no effect) was considered a large effect. For
standardised mean differences, an effect size of 0.1 was considered small, 0.3 medium and 0.5 large.
Evidence profile
Evidence was found for 8 of the 10 comparisons and results of these studies are summarised in the
following GRADE tables (for full evidence profiles see Appendix I):
Table 9.2 − paracetamol compared with placebo
Table 9.3 − ibuprofen compared with placebo
Table 9.4 − paracetamol compared with ibuprofen
Table 9.5 −paracetamol compared with paracetamol and ibuprofen combined
Table 9.6 − paracetamol compared with paracetamol and ibuprofen alternating
Table 9.7 − ibuprofen compared with paracetamol and ibuprofen combined
Table 9.8 − ibuprofen vparacetamol and ibuprofen alternating
Table 9.9 − paracetamol and ibuprofen combined compared with paracetamol and
ibuprofen alternating.
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2013 Update