Paracetamol prolongs clearance of malaria, and time to total scabbing in chickenpox. So only give for symptomatic benefit, not as routine!
Cochrane did not find any evidence that drugs prevent febrile convulsions, but not much data. Not recommended. Tepid sponging probably does work, but is inferior to drugs.
Ibuprofen probably works a bit quicker, and lasts longer. [Arch Peds Adol Metanalysis, 2004. PMID 15184213]
Alternating paracetamol and ibuprofen was superior in an Israeli study and in a US study.[Arch ped adol 2006 PMID 16461878, Clin peds 2008 PMID 18539869]
Combined? PITCH found combination was more effective than either alone (reducing time with fever over a 24 hour period by 2.5 hours or more) although it did not work faster than ibuprofen alone. No specific benefit was found for symptoms although it was underpowered for subjective comfort. [BMJ 2008 PMID 18765450] A linked cost benefit analysis suggested financial benefits to society for using the combination. On the other hand, use of the combination was associated with significant rates of medication errors and it could be argued that this risk outweighs the potential benefits.
Ibuprofen used as an antipyretic in febrile children with a past medical history of asthma is as least as safe as paracetamol and not likely to exacerbate asthma. [Lesko, Peds 2002]
- Antipyretic agents (drugs that reduce fever) do not prevent febrile convulsions and should not be used specifically for this purpose.
- When using paracetamol or ibuprofen in children with fever;
- continue only as long as the child appears distressed
- consider changing to the other agent if the child’s distress is not alleviated
- do not give both agents simultaneously
- only consider alternating these agents if the distress persists or if it recurs before the next dose is due.
[NICE feverish illness update May 2013 – new CG code: 160]