Alternating Acetaminophen and Ibuprofen versus Monotherapies in Improvements of Distress and Reducing Refractory Fever in Febrile Children: A Randomized Controlled Trial
Background No evidence can be found in the medical literature about the efficacy of alternating acetaminophen and ibuprofen treatment in children with refractory fever. Objective Our objective was to assess the effect of alternating acetaminophen and ibuprofen therapy on distress and refractory feve...
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| Veröffentlicht in: | Paediatric drugs 2017-10, Vol.19 (5), p.479-486 |
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| creator | Luo, Shuanghong Ran, Mengdong Luo, Qiuhong Shu, Min Guo, Qin Zhu, Yu Xie, Xiaoping Zhang, Chongfan Wan, Chaomin |
| description | Background
No evidence can be found in the medical literature about the efficacy of alternating acetaminophen and ibuprofen treatment in children with refractory fever.
Objective
Our objective was to assess the effect of alternating acetaminophen and ibuprofen therapy on distress and refractory fever compared with acetaminophen or ibuprofen as monotherapy in febrile children.
Methods
A total of 474 febrile children with axillary temperature ≥38.5 °C and fever history ≤3 days in a tertiary hospital were randomly assigned to receive either (1) alternating acetaminophen and ibuprofen (acetaminophen 10 mg/kg per dose with shortest interval of 4 h and ibuprofen 10 mg/kg per dose with shortest interval of 6 h and the shortest interval between acetaminophen and ibuprofen ≥2 h;
n
= 158), (2) acetaminophen monotherapy (10 mg/kg per dose with shortest interval of 4 h;
n
= 158), or (3) ibuprofen monotherapy (10 mg/kg per dose with shortest interval of 6 h;
n
= 158). The mean Non-Communicating Children’s Pain Checklist (NCCPC) score was measured every 4 h, and axillary temperatures were measured every 2 h.
Results
In total, 471 children were included in an intention-to-treat analysis. No significant clinical or statistical difference was found in mean NCCPC score or temperature during the 24-h treatment period in all febrile children across the three groups. Although the proportion of children with refractory fever for 4 h and 6 h was significantly lower in the alternating group than in the monotherapy groups (4 h: 11.54% vs. 26.58% vs. 21.66%, respectively [
p
= 0.003]; 6 h: 3.85% vs. 10.13% vs. 17.83%, respectively [
p
|
| doi_str_mv | 10.1007/s40272-017-0237-1 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_journals_1973321970</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A714590726</galeid><sourcerecordid>A714590726</sourcerecordid><originalsourceid>FETCH-LOGICAL-c439t-32dba4a0dba5955406bbe57420f5cc524ef68b7bc5ef13f8335a703a72dcf1933</originalsourceid><addsrcrecordid>eNp1kV1rFDEUhgex2Fr9Ad5IwOup-ZhsZrwbVlcXKoWlvQ6ZzMluSiZZk0yh_iP_pdlu_QJL4OSEvM9LTt6qekPwBcFYvE8NpoLWmIgaUyZq8qw6I0R0NcWke_7QNzVvRXtavUzpFhchW9AX1SltOWW87c6qH73LEL3K1m9RryGryfqw34FHyo9oPcz7GEw53UFMc0Jfgw95B1HtLSRkPVpPRXAHE_icUDDoo005QkoP-AbGWR-cN2Ci0jnEe7SCYnUgVzBE6wAtd9aNEfwH1KNNocJkv8OIlsHnGJwr7XW0yr2qToxyCV4_7ufVzerT9fJLfXn1eb3sL2vdsC7XjI6DahQulXecN3gxDMBFQ7HhWnPagFm0gxg0B0OYaRnjSmCmBB21IR1j59W7o2-Z69sMKcvbMJcfckmSTjBGS8V_VFvlQFpvQi4DTjZp2QvS8A4Luiiqi_-oyhphsjp4MOUD_gXIEdAxpBTByH20k4r3kmB5yFweM5clSnnIXJLCvH188DxMMP4mfoVcBPQoSOXKbyH-NdGTrj8BHFi4tQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1973321970</pqid></control><display><type>article</type><title>Alternating Acetaminophen and Ibuprofen versus Monotherapies in Improvements of Distress and Reducing Refractory Fever in Febrile Children: A Randomized Controlled Trial</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Luo, Shuanghong ; Ran, Mengdong ; Luo, Qiuhong ; Shu, Min ; Guo, Qin ; Zhu, Yu ; Xie, Xiaoping ; Zhang, Chongfan ; Wan, Chaomin</creator><creatorcontrib>Luo, Shuanghong ; Ran, Mengdong ; Luo, Qiuhong ; Shu, Min ; Guo, Qin ; Zhu, Yu ; Xie, Xiaoping ; Zhang, Chongfan ; Wan, Chaomin</creatorcontrib><description>Background
No evidence can be found in the medical literature about the efficacy of alternating acetaminophen and ibuprofen treatment in children with refractory fever.
Objective
Our objective was to assess the effect of alternating acetaminophen and ibuprofen therapy on distress and refractory fever compared with acetaminophen or ibuprofen as monotherapy in febrile children.
Methods
A total of 474 febrile children with axillary temperature ≥38.5 °C and fever history ≤3 days in a tertiary hospital were randomly assigned to receive either (1) alternating acetaminophen and ibuprofen (acetaminophen 10 mg/kg per dose with shortest interval of 4 h and ibuprofen 10 mg/kg per dose with shortest interval of 6 h and the shortest interval between acetaminophen and ibuprofen ≥2 h;
n
= 158), (2) acetaminophen monotherapy (10 mg/kg per dose with shortest interval of 4 h;
n
= 158), or (3) ibuprofen monotherapy (10 mg/kg per dose with shortest interval of 6 h;
n
= 158). The mean Non-Communicating Children’s Pain Checklist (NCCPC) score was measured every 4 h, and axillary temperatures were measured every 2 h.
Results
In total, 471 children were included in an intention-to-treat analysis. No significant clinical or statistical difference was found in mean NCCPC score or temperature during the 24-h treatment period in all febrile children across the three groups. Although the proportion of children with refractory fever for 4 h and 6 h was significantly lower in the alternating group than in the monotherapy groups (4 h: 11.54% vs. 26.58% vs. 21.66%, respectively [
p
= 0.003]; 6 h: 3.85% vs. 10.13% vs. 17.83%, respectively [
p
< 0.001]), the mean NCCPC score of children with refractory fever for 4 or 6 h was not lower than those in either of the monotherapy groups. The number of patients who developed persistent high body temperature was consistent across all study groups.
Conclusions
Alternating acetaminophen and ibuprofen can reduce the proportion of children with refractory fever, but if one cycle of alternating therapy cannot reduce febrile distress as defined by NCCPC score, two or more cycles of alternating therapy may have minimal to no clinical efficacy in some cases.
The trial was registered with the Chinese Clinical Trial Registry as ChiCTR-TRC-13003440 and the WHO Registry Network as U1111-1146-6714.</description><identifier>ISSN: 1174-5878</identifier><identifier>EISSN: 1179-2019</identifier><identifier>DOI: 10.1007/s40272-017-0237-1</identifier><identifier>PMID: 28523589</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Acetaminophen ; Acetaminophen - therapeutic use ; Analgesics ; Antipyretics - therapeutic use ; Child ; Child, Preschool ; Children & youth ; Clinical trials ; Complications and side effects ; Dosage and administration ; Drug Administration Schedule ; Drug dosages ; Drug therapy ; Drug Therapy, Combination ; Febrile convulsions ; Female ; Fever ; Fever - drug therapy ; Fever - physiopathology ; Fever in children ; Humans ; Ibuprofen ; Ibuprofen - therapeutic use ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Nonsteroidal anti-inflammatory drugs ; Original Research Article ; Pain ; Patient outcomes ; Pediatrics ; Pharmacotherapy ; Prospective Studies ; Researchers ; Systematic review ; Temperature ; Tertiary Care Centers</subject><ispartof>Paediatric drugs, 2017-10, Vol.19 (5), p.479-486</ispartof><rights>Springer International Publishing Switzerland 2017</rights><rights>COPYRIGHT 2017 Springer</rights><rights>Copyright Springer Science & Business Media Oct 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-32dba4a0dba5955406bbe57420f5cc524ef68b7bc5ef13f8335a703a72dcf1933</citedby><cites>FETCH-LOGICAL-c439t-32dba4a0dba5955406bbe57420f5cc524ef68b7bc5ef13f8335a703a72dcf1933</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s40272-017-0237-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s40272-017-0237-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28523589$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luo, Shuanghong</creatorcontrib><creatorcontrib>Ran, Mengdong</creatorcontrib><creatorcontrib>Luo, Qiuhong</creatorcontrib><creatorcontrib>Shu, Min</creatorcontrib><creatorcontrib>Guo, Qin</creatorcontrib><creatorcontrib>Zhu, Yu</creatorcontrib><creatorcontrib>Xie, Xiaoping</creatorcontrib><creatorcontrib>Zhang, Chongfan</creatorcontrib><creatorcontrib>Wan, Chaomin</creatorcontrib><title>Alternating Acetaminophen and Ibuprofen versus Monotherapies in Improvements of Distress and Reducing Refractory Fever in Febrile Children: A Randomized Controlled Trial</title><title>Paediatric drugs</title><addtitle>Pediatr Drugs</addtitle><addtitle>Paediatr Drugs</addtitle><description>Background
No evidence can be found in the medical literature about the efficacy of alternating acetaminophen and ibuprofen treatment in children with refractory fever.
Objective
Our objective was to assess the effect of alternating acetaminophen and ibuprofen therapy on distress and refractory fever compared with acetaminophen or ibuprofen as monotherapy in febrile children.
Methods
A total of 474 febrile children with axillary temperature ≥38.5 °C and fever history ≤3 days in a tertiary hospital were randomly assigned to receive either (1) alternating acetaminophen and ibuprofen (acetaminophen 10 mg/kg per dose with shortest interval of 4 h and ibuprofen 10 mg/kg per dose with shortest interval of 6 h and the shortest interval between acetaminophen and ibuprofen ≥2 h;
n
= 158), (2) acetaminophen monotherapy (10 mg/kg per dose with shortest interval of 4 h;
n
= 158), or (3) ibuprofen monotherapy (10 mg/kg per dose with shortest interval of 6 h;
n
= 158). The mean Non-Communicating Children’s Pain Checklist (NCCPC) score was measured every 4 h, and axillary temperatures were measured every 2 h.
Results
In total, 471 children were included in an intention-to-treat analysis. No significant clinical or statistical difference was found in mean NCCPC score or temperature during the 24-h treatment period in all febrile children across the three groups. Although the proportion of children with refractory fever for 4 h and 6 h was significantly lower in the alternating group than in the monotherapy groups (4 h: 11.54% vs. 26.58% vs. 21.66%, respectively [
p
= 0.003]; 6 h: 3.85% vs. 10.13% vs. 17.83%, respectively [
p
< 0.001]), the mean NCCPC score of children with refractory fever for 4 or 6 h was not lower than those in either of the monotherapy groups. The number of patients who developed persistent high body temperature was consistent across all study groups.
Conclusions
Alternating acetaminophen and ibuprofen can reduce the proportion of children with refractory fever, but if one cycle of alternating therapy cannot reduce febrile distress as defined by NCCPC score, two or more cycles of alternating therapy may have minimal to no clinical efficacy in some cases.
The trial was registered with the Chinese Clinical Trial Registry as ChiCTR-TRC-13003440 and the WHO Registry Network as U1111-1146-6714.</description><subject>Acetaminophen</subject><subject>Acetaminophen - therapeutic use</subject><subject>Analgesics</subject><subject>Antipyretics - therapeutic use</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children & youth</subject><subject>Clinical trials</subject><subject>Complications and side effects</subject><subject>Dosage and administration</subject><subject>Drug Administration Schedule</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Febrile convulsions</subject><subject>Female</subject><subject>Fever</subject><subject>Fever - drug therapy</subject><subject>Fever - physiopathology</subject><subject>Fever in children</subject><subject>Humans</subject><subject>Ibuprofen</subject><subject>Ibuprofen - therapeutic use</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Original Research Article</subject><subject>Pain</subject><subject>Patient outcomes</subject><subject>Pediatrics</subject><subject>Pharmacotherapy</subject><subject>Prospective Studies</subject><subject>Researchers</subject><subject>Systematic review</subject><subject>Temperature</subject><subject>Tertiary Care Centers</subject><issn>1174-5878</issn><issn>1179-2019</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kV1rFDEUhgex2Fr9Ad5IwOup-ZhsZrwbVlcXKoWlvQ6ZzMluSiZZk0yh_iP_pdlu_QJL4OSEvM9LTt6qekPwBcFYvE8NpoLWmIgaUyZq8qw6I0R0NcWke_7QNzVvRXtavUzpFhchW9AX1SltOWW87c6qH73LEL3K1m9RryGryfqw34FHyo9oPcz7GEw53UFMc0Jfgw95B1HtLSRkPVpPRXAHE_icUDDoo005QkoP-AbGWR-cN2Ci0jnEe7SCYnUgVzBE6wAtd9aNEfwH1KNNocJkv8OIlsHnGJwr7XW0yr2qToxyCV4_7ufVzerT9fJLfXn1eb3sL2vdsC7XjI6DahQulXecN3gxDMBFQ7HhWnPagFm0gxg0B0OYaRnjSmCmBB21IR1j59W7o2-Z69sMKcvbMJcfckmSTjBGS8V_VFvlQFpvQi4DTjZp2QvS8A4Luiiqi_-oyhphsjp4MOUD_gXIEdAxpBTByH20k4r3kmB5yFweM5clSnnIXJLCvH188DxMMP4mfoVcBPQoSOXKbyH-NdGTrj8BHFi4tQ</recordid><startdate>20171001</startdate><enddate>20171001</enddate><creator>Luo, Shuanghong</creator><creator>Ran, Mengdong</creator><creator>Luo, Qiuhong</creator><creator>Shu, Min</creator><creator>Guo, Qin</creator><creator>Zhu, Yu</creator><creator>Xie, Xiaoping</creator><creator>Zhang, Chongfan</creator><creator>Wan, Chaomin</creator><general>Springer International Publishing</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20171001</creationdate><title>Alternating Acetaminophen and Ibuprofen versus Monotherapies in Improvements of Distress and Reducing Refractory Fever in Febrile Children: A Randomized Controlled Trial</title><author>Luo, Shuanghong ; Ran, Mengdong ; Luo, Qiuhong ; Shu, Min ; Guo, Qin ; Zhu, Yu ; Xie, Xiaoping ; Zhang, Chongfan ; Wan, Chaomin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-32dba4a0dba5955406bbe57420f5cc524ef68b7bc5ef13f8335a703a72dcf1933</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acetaminophen</topic><topic>Acetaminophen - therapeutic use</topic><topic>Analgesics</topic><topic>Antipyretics - therapeutic use</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children & youth</topic><topic>Clinical trials</topic><topic>Complications and side effects</topic><topic>Dosage and administration</topic><topic>Drug Administration Schedule</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Drug Therapy, Combination</topic><topic>Febrile convulsions</topic><topic>Female</topic><topic>Fever</topic><topic>Fever - drug therapy</topic><topic>Fever - physiopathology</topic><topic>Fever in children</topic><topic>Humans</topic><topic>Ibuprofen</topic><topic>Ibuprofen - therapeutic use</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Original Research Article</topic><topic>Pain</topic><topic>Patient outcomes</topic><topic>Pediatrics</topic><topic>Pharmacotherapy</topic><topic>Prospective Studies</topic><topic>Researchers</topic><topic>Systematic review</topic><topic>Temperature</topic><topic>Tertiary Care Centers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luo, Shuanghong</creatorcontrib><creatorcontrib>Ran, Mengdong</creatorcontrib><creatorcontrib>Luo, Qiuhong</creatorcontrib><creatorcontrib>Shu, Min</creatorcontrib><creatorcontrib>Guo, Qin</creatorcontrib><creatorcontrib>Zhu, Yu</creatorcontrib><creatorcontrib>Xie, Xiaoping</creatorcontrib><creatorcontrib>Zhang, Chongfan</creatorcontrib><creatorcontrib>Wan, Chaomin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>Paediatric drugs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luo, Shuanghong</au><au>Ran, Mengdong</au><au>Luo, Qiuhong</au><au>Shu, Min</au><au>Guo, Qin</au><au>Zhu, Yu</au><au>Xie, Xiaoping</au><au>Zhang, Chongfan</au><au>Wan, Chaomin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Alternating Acetaminophen and Ibuprofen versus Monotherapies in Improvements of Distress and Reducing Refractory Fever in Febrile Children: A Randomized Controlled Trial</atitle><jtitle>Paediatric drugs</jtitle><stitle>Pediatr Drugs</stitle><addtitle>Paediatr Drugs</addtitle><date>2017-10-01</date><risdate>2017</risdate><volume>19</volume><issue>5</issue><spage>479</spage><epage>486</epage><pages>479-486</pages><issn>1174-5878</issn><eissn>1179-2019</eissn><abstract>Background
No evidence can be found in the medical literature about the efficacy of alternating acetaminophen and ibuprofen treatment in children with refractory fever.
Objective
Our objective was to assess the effect of alternating acetaminophen and ibuprofen therapy on distress and refractory fever compared with acetaminophen or ibuprofen as monotherapy in febrile children.
Methods
A total of 474 febrile children with axillary temperature ≥38.5 °C and fever history ≤3 days in a tertiary hospital were randomly assigned to receive either (1) alternating acetaminophen and ibuprofen (acetaminophen 10 mg/kg per dose with shortest interval of 4 h and ibuprofen 10 mg/kg per dose with shortest interval of 6 h and the shortest interval between acetaminophen and ibuprofen ≥2 h;
n
= 158), (2) acetaminophen monotherapy (10 mg/kg per dose with shortest interval of 4 h;
n
= 158), or (3) ibuprofen monotherapy (10 mg/kg per dose with shortest interval of 6 h;
n
= 158). The mean Non-Communicating Children’s Pain Checklist (NCCPC) score was measured every 4 h, and axillary temperatures were measured every 2 h.
Results
In total, 471 children were included in an intention-to-treat analysis. No significant clinical or statistical difference was found in mean NCCPC score or temperature during the 24-h treatment period in all febrile children across the three groups. Although the proportion of children with refractory fever for 4 h and 6 h was significantly lower in the alternating group than in the monotherapy groups (4 h: 11.54% vs. 26.58% vs. 21.66%, respectively [
p
= 0.003]; 6 h: 3.85% vs. 10.13% vs. 17.83%, respectively [
p
< 0.001]), the mean NCCPC score of children with refractory fever for 4 or 6 h was not lower than those in either of the monotherapy groups. The number of patients who developed persistent high body temperature was consistent across all study groups.
Conclusions
Alternating acetaminophen and ibuprofen can reduce the proportion of children with refractory fever, but if one cycle of alternating therapy cannot reduce febrile distress as defined by NCCPC score, two or more cycles of alternating therapy may have minimal to no clinical efficacy in some cases.
The trial was registered with the Chinese Clinical Trial Registry as ChiCTR-TRC-13003440 and the WHO Registry Network as U1111-1146-6714.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>28523589</pmid><doi>10.1007/s40272-017-0237-1</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1174-5878 |
| ispartof | Paediatric drugs, 2017-10, Vol.19 (5), p.479-486 |
| issn | 1174-5878 1179-2019 |
| language | eng |
| recordid | cdi_proquest_journals_1973321970 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Acetaminophen Acetaminophen - therapeutic use Analgesics Antipyretics - therapeutic use Child Child, Preschool Children & youth Clinical trials Complications and side effects Dosage and administration Drug Administration Schedule Drug dosages Drug therapy Drug Therapy, Combination Febrile convulsions Female Fever Fever - drug therapy Fever - physiopathology Fever in children Humans Ibuprofen Ibuprofen - therapeutic use Internal Medicine Male Medicine Medicine & Public Health Nonsteroidal anti-inflammatory drugs Original Research Article Pain Patient outcomes Pediatrics Pharmacotherapy Prospective Studies Researchers Systematic review Temperature Tertiary Care Centers |
| title | Alternating Acetaminophen and Ibuprofen versus Monotherapies in Improvements of Distress and Reducing Refractory Fever in Febrile Children: A Randomized Controlled Trial |
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