Recent systematic reviews have concluded that there is little evidence of any significant click here benefit (or harm) from combined or alternating treatment compared with the use of either drug alone [80, 81] and, in their recent update, Akt inhibitor review NICE concluded that there was little evidence in the community that alternating therapy improves distress. Alternating the two agents is therefore only recommended if both have been ineffective as standalone treatments [2], the proviso

being how a parent defines ‘ineffective’. Factors such as parental anxiety, poorly obtained or recorded temperatures, subjective assessment of level of discomfort or distress, and a lack of knowledge on the time to onset of antipyretic effect may contribute both to dosing more frequently than recommended and to a perceived lack of response to monotherapy, resulting in unnecessary (and potentially harmful) use of alternating therapy [15]. A further consideration regarding alternating treatment is the possibility of parental confusion, which may result in accidental overdose or underdosing [15, 82, 83]. While

the recommended dosing interval for ibuprofen is 6 hours, it is 4 hours for paracetamol, therefore a simple alternating dosing regimen can be difficult. It is possible that treatment GW2580 price with a single combined dose of ibuprofen and paracetamol may offer a more effective option, with a reduced risk of dosing confusion compared with alternating therapy. There is a theoretical benefit to the co-administration of two antipyretics with different modes of action. Data in adults suggest that co-administration of ibuprofen and paracetamol provides highly effective pain relief [84] and antipyretic efficacy [85] (although distress was not measured in these patients), with a similar safety profile to each agent alone [86]. However, Miconazole efficacy and safety data for combination therapy in children are lacking and, therefore, currently the author’s recommendation

would be that this practice is not suggested for general OTC usage, in agreement with the latest NICE recommendations. 4 Summary and Conclusions The NICE guidelines give equal recommendation to the use of paracetamol or ibuprofen for the short-term treatment of distress in low-risk feverish children [2]. Therefore, the caregiver or HCP has to make a choice between these readily available OTC agents. The aim of this review has been to compile and compare the efficacy and safety data from available clinical studies that directly compare ibuprofen and paracetamol such that any clinically relevant differences can be considered and sensible conclusions drawn as to whether one agent has advantage over the other, and to enable the caregiver (or HCP) to make an informed choice.