New Advice For Treating Fever In Children

Ruzanna Harutyunyan's picture
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Ibuprofen reduces a child's temperature faster and for longer than paracetamol, in the first four hours a child has a fever. If the fever persists, then children should be given ibuprofen plus paracetamol, according to a study published today online at BMJ.com.

The work was carried out by the University of Bristol and the University of the West of England, with support from the NHS in Bristol. The children in the study were recruited from 35 Bristol primary care sites, thanks to help from the local media in Bristol.

The research shows that giving ibuprofen to children under six reduced the amount of time they spent with fever in the first four hours by 40 minutes, compared with giving paracetamol.

When both medicines were alternated over a 24-hour period, children spent nearly 4.5 hours less time with fever, compared with giving paracetamol on its own, and 2.5 hours less time with fever, when compared with giving ibuprofen on its own.

In light of this evidence the authors say that national guidelines, which caution that the medicines should not be used in combination, should be reviewed. These guidelines were published last year by the National Institute for Health and Clinical Excellence (NICE).

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Dr Alastair Hay, a Senior Lecturer at Bristol University's Department of Community-based Medicine and a local GP, said: “Advice given to parents regarding which medicine to use can be confusing, especially at a time when they are worried about their child. Our NHS-funded 'PITCH' fever study set out to investigate the most effective medicine for children unwell with a fever – paracetamol, ibuprofen, or both.

“If symptoms persist despite ibuprofen, then alternating both medicines is probably superior to using either medicine alone, but if two medicines are used, parents need to be careful to avoid accidentally giving too much.”

A team of researchers from the University of Bristol and the University of the West of England, recruited 156 children aged between six months and six years old who had a temperature between 37.8 and 41 degrees centigrade, due to an illness that could be managed at home. Children were randomised to receive either paracetamol plus ibuprofen, just paracetamol, or just ibuprofen.

Using two medicines does not appear to cost parents or the NHS any more than using one medicine. The results also show that using both medicines may also be the least expensive option for parents – because they took less time off work, and for the NHS – because of fewer GP visits.

Dr Hay added: “Children with a high temperature should be lightly dressed and given plenty to drink. When parents or healthcare professionals wish to use medicines to help relieve symptoms, ibuprofen is the most effective in the first 4 hours. If more sustained symptom control over a 24-hour period is wanted, giving both medicines alternately is better than giving one on its own.

“However, parents should keep a careful record of when doses are given to avoid accidentally giving too much. If a parent is concerned about the underlying cause for their child's fever, they should seek medical advice. I am very grateful to the parents, children and local doctors and nurses who supported the study and hope that they will help us with future studies.”

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