Acetaminophen plus ibuprofen and ibuprofen alone are equally effective in reducing fever.

Fever is one of the most common reasons for pediatric office visits and a source of anxiety for parents. Although we educate families that fever does not require treatment, parents often want to use antipyretics to provide some relief. Previous studies have shown that acetaminophen and ibuprofen alone is better than placebo for reducing fever and that ibuprofen is better than acetaminophen (JW Pediatr Adolesc Med Jul 26 2004). To compare the effectiveness of these agents, investigators randomized 156 children (age range, 6 months to 6 years) who had temperatures between 37.8°C and 41.0°C to receive acetaminophen alone (15 mg/kg every 4–6 hours), ibuprofen alone (10 mg/kg every 6–8 hours), or both drugs in alternating order (determined randomly) at home during the first 24 hours of the illness, regardless of symptoms or height of fever. Parents were instructed to give medication on the second day only in response to their child’s symptoms.

Time until fever clearance was similar for children who received ibuprofen alone and those who received ibuprofen plus acetaminophen, and both ibuprofen regimens were superior to acetaminophen alone (time to fever clearance, 42.2 and 44.5 minutes vs. 71.0 minutes, respectively). Children who received both antipyretics were afebrile for longer periods during the first 24 hours than were those who received acetaminophen alone or ibuprofen alone (4.4 hours and 2.5 hours longer, respectively). No significant differences in fever-associated symptoms were noted between treatment groups after the first 24 hours.

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Although a combination of acetaminophen and ibuprofen can keep children afebrile for longer periods of …