A5V4d

Antipyretic interventions
Two RCTs found no difference in temperature reduction in children who received paracetamol and
ibuprofen combined compared with children who received paracetamol only to treat fever. The
evidence for this finding was of moderate quality.
One RCT found that the proportion of afebrile patients was higher in children who received
paracetamol and ibuprofen combined compared with children who received paracetamol alone to
treat fever up until 6 hours after treatment, but no difference between groups thereafter. This was a
large effect and the finding was statistically significant. The evidence for this finding was of moderate
quality.
One RCT found that total time without fever was longer in children who received paracetamol and
ibuprofen combined compared with children who received paracetamol to treat fever up until 24 hours
after treatment began. This finding was statistically significant. The evidence for this finding was of
moderate quality.
One RCT reported no difference in adverse events between paracetamol and ibuprofen combined
and paracetamol alone.
Paracetamol compared with paracetamol and ibuprofen alternating
One RCT found quality of life (discomfort) was less up to 3 days after treatment began in children who
received alternating paracetamol and ibuprofen compared to children who received only paracetamol
to treat fever. This finding was statistically significant. The evidence for this finding was of high quality.
Two RCTs found that temperature was reduced more in children who received alternating
paracetamol and ibuprofen compared to children who received only paracetamol to treat fever. This
finding was statistically significant at 5 hours, 8 hours and from 1 to 3 days after treatment began. The
effect size was moderate to high. The evidence was of high to very low quality.
No adverse events were reported.
Ibuprofen compared with paracetamol and ibuprofen combined
One RCT found no difference in quality of life up to 5 days after treatment began in children who
received paracetamol and ibuprofen combined compared with children who received only ibuprofen to
treat fever. The evidence for this finding was of low quality.
Three RCTs found no difference in temperature reduction in children who received paracetamol and
ibuprofen combined compared with children who received only ibuprofen to treat fever. The evidence
for this finding was of moderate quality.
Two RCTs found no difference in the proportion of children who were afebrile when comparing
children who received ibuprofen and paracetamol combined with children who received only ibuprofen
to treat fever up to 3 hours after treatment began. Between 4 and 8 hours combined therapy had a
higher proportion of afebrile children. This finding was statistically significant. The evidence for this
finding was of moderate to low quality.
One RCT study found that total time without fever was longer in children who received paracetamol
and ibuprofen combined compared with children who received ibuprofen to treat fever up until 24
hours after treatment began. This finding was statistically significant. The evidence for this finding was
of moderate quality.
One RCT study reported no difference in adverse events between paracetamol and ibuprofen
combined and paracetamol alone.
Ibuprofen compared with paracetamol and ibuprofen alternating
One RCT found discomfort (quality of life) was less up to 3 days after treatment began in children who
received alternating paracetamol and ibuprofen compared with children who received ibuprofen only
to treat fever. This finding was statistically significant. The evidence for this finding was high quality.
Three RCTs found that temperature was reduced more in children who received alternating
paracetamol and ibuprofen compared with children who received only paracetamol to treat fever. This
finding was statistically significant at 5 hours and from 1 to 3 days after treatment began. The effect
size was moderate to high. The evidence was of high to very low quality.
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2013 Update