PEDIATRICS Vol. 105 No. 5 May 2000, pp. 1009-1012
Alternating Antipyretics: Is This an Alternative?
Received Apr 23, 1999; accepted Sep 23, 1999.
From the Department of Pediatrics, Winthrop University Hopsital, Mineola, New York.
Objectives. To identify current fever management strategies and their basis, and to assess the frequency of alternating acetaminophen and ibuprofen.
Background. Practicing pediatricians confront the dilemma of elevated temperature and the anxiety this creates for parents. An informal survey of pediatricians revealed a variety of management strategies, including alternating acetaminophen and ibuprofen. There are no scientific data regarding alternating these 2 products.
Design. During professional meetings, pediatricians voluntarily filled out a 15-item questionnaire.
Results. One hundred sixty-one completed surveys were
reviewed. Respondents were mostly general pediatricians (67.7%), with
20 years in practice (55.9%). Most respondents chose a temperature
of 101oF to start antipyretic treatment (61.9%). A small
percentage used discomfort alone as the indication (13%). The
antipyretic of choice was temperature-dependent in 50% of respondents;
57% used ibuprofen for temperature 102°F. Fifty percent of
respondents advised parents to alternate acetaminophen and ibuprofen.
The method of alternation varied. The most common answers given for
choosing a particular antipyretic regime were recommendations of the
American Academy of Pediatrics (29%) and opinions of colleagues and
mentors (25%). Physicians with <5 years of practice were
significantly more likely to alternate antipyretics
(69.7%).
Conclusion. Acetaminophen and ibuprofen are commonly being used in an alternating manner for management of fever. There is presently no scientific evidence that this combination is safe or achieves faster antipyresis than either agent alone. There is evidence that the improper use of these agents may cause harm. Despite 29% of participants citing American Academy of Pediatrics recommendations as the basis for fever management, no such policy or recommendations exist. The observation that this practice is more common in younger practitioners may reflect their continued anxiety about fever (fever phobia). Until properly controlled studies have assessed the risk of combining these 2 products, practitioners should proceed with caution. Key words: antipyretics, acetaminophen, ibuprofen, fever.
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