Monday, November 30, 2009

Tylenol and Iburpofen to treat fever in children???

First, it must be made clear that any child with a fever should be evaluated by a physician to determine if antibiotics or a higher level of care is required, especially during H1N1 season.

That being said, you have a child who doesn't have any other source of infection other than a viral illness and now what do you do. There are a lot of theories as to whether you should treat it or not with medications like tylenol and ibuprofen. I will leave that up to parents to decide. My opinion is that when you treat a fever, the child feels better, sleeps better and is able to return to normal activities. Typically children greater than 1 year can have either tylenol or ibuprofen. Some viral illnesses will have a high fever and many parents will call when they can't give another dose based on the bottle instruction and child's fever, breaks through. When that happens, I recommend alternating doses of tylenol and iburpofen every 4 hours so their is at least 8 hours between doses of the same medications. I will even recommend mom set an alarm and wake the child up in the middle of the night to give them some medicine and some fluids and have them go back to bed. Attached is an article about using both medications is better. Read for yourself.

Bryan Glick, DO

Journal of Family Practice
December 2008 (Vol. 57, No. 12)
Patient Oriented Evidence that Matters

Do combination antipyretics work faster than ibuprofen alone in children?

Hay AD, Costelloe C, Redmond NM, et al. Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial. BMJ. 2008;337:a1302.

No. Adding acetaminophen (paracetamol) to ibuprofen does not reduce fever faster than ibuprofen alone in children. Over 24 hours, however, children receiving the combination spent 2.5 to 4.4 more hours without fever than children who took either drug alone.
Individual randomized controlled trials (with narrow confidence interval)
These investigators enrolled 156 children ages 6 months to 6 years at 35 primary care sites. The children were un-well and had a fever of at least 37.8°C, but no more than 41.0°C, and could be cared for at home. Children with dehydration were excluded.
The children were randomly assigned (concealed allocation) to receive ibuprofen 10 mg/kg per dose every 8 hours, acetaminophen 15 mg/kg per dose every 6 hours, or the combination, for the first 24 hours and then in response to symptoms for another 24 hours. The first doses were given in the office upon enrollment. Matching placebo of the alternate drug was given to the children in the single-drug groups. Analysis was by intent-to-treat, ie, the children were analyzed in the group to which they were assigned regardless of whether they followed the advice for therapy. Over the first 24 hours, full dosing of acetaminophen occurred in 42% to 65% of children and full dosing of ibuprofen occurred in 71% to 73% of children.

Combination antipyretics don’t work faster than ibuprofen, but they are longer acting
Ibuprofen lengthens time without fever during first 4 hours
Ibuprofen, either alone or with acetaminophen, produced more time without fever in the first 4 hours—an additional 55 minutes with the combination and an extra 39 minutes with ibuprofen alone—as compared with acetaminophen alone. This difference resulted from a 23- to 26-minute faster onset of fever reduction when ibuprofen was used either in combination with acetaminophen or alone.
Combination therapy has benefits during the 24-hour window
Over the first 24 hours, children spent more time afebrile with the combination of drugs as compared with either drug alone: 20.3 hours as compared with 15.7 hours with acetaminophen alone and 17.6 hours with ibuprofen alone.