When they are ill with infections, children often develop a fever. The
fever with common viral illnesses, such as colds, coughs, sore throats
and gastrointestinal illness, usually lasts a few days, makes children
feel unwell, and is distressing for the children, their parents, or
Paracetamol (also known as acetaminophen) and ibuprofen lower the
child's temperature and relieve their discomfort. This review evaluates
whether giving both treatments together, or alternating the two
treatments, is more effective than giving paracetamol or ibuprofen
In September 2013, we found six studies, involving 915 children, that
evaluated combined or alternating paracetamol and ibuprofen to treat
fever in children.
Compared to giving ibuprofen or paracetamol alone, giving both
medications together is probably more effective at lowering temperature
for the first four hours after treatment (moderate quality evidence).
However, only one trial assessed whether combined treatment made
children less uncomfortable or distressed and found no difference
compared to ibuprofen or paracetamol alone.
In practice, caregivers are often advised to initially give a single
agent (paracetamol or ibuprofen), and then give a further dose of the
alternative if the child continues to have a fever. Giving alternating
treatment in this way may be more effective at lowering temperature for
the first three hours after the second dose (low quality evidence), and
may also result in less child discomfort (low quality evidence).
Only one small trial compared alternating therapy with combined therapy
and found no advantages between the two (very low quality evidence).
Wong, T.; Stang, A.S.; Ganshorn, H.; Hartling, L.; Maconochie, I.K.; Thomsen, A.M.; Johnson, D.W. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Cochrane Database of Systematic Reviews (2013) Issue 10, Art. No.: CD009572. [DOI: 10.1002/14651858.CD009572.pub2]
Combined and alternating paracetamol and ibuprofen therapy for febrile children