• E Michael Sarrell, Eliahu Wielunsky, and Herman Avner Cohen.
• Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. sarrell@netvision.net.il
• Arch Pediat Adol Med. 2006 Feb 1;160(2):197-202.

ObjectiveTo compare the antipyretic benefit of acetaminophen or ibuprofen monotherapy with an alternating regimen of both drugs in young children aged 6 to 36 months.DesignRandomized, double-blind, parallel-group trial.SettingThree primary pediatric community ambulatory centers in central Israel.ParticipantsA total of 464 children aged 6 to 36 months with fever.InterventionInfants were assigned to receive either acetaminophen (12.5 mg/kg per dose every 6 hours) (n = 154) or ibuprofen (5 mg/kg per dose every 8 hours) (n = 155) or to receive alternating acetaminophen and ibuprofen (every 4 hours) (n = 155) for 3 days after a loading dose.Main Outcome MeasuresTemperature, stress score, amount of antipyretic received, total days that the infant or caregiver was absent from day care or work, respectively, at the 3-day time point, recurrence of fever, and number of emergency department visits.ResultsThe group given the alternating regimen was characterized by a lower mean temperature, more rapid reduction of fever, receiving less antipyretic medication, less stress, and less absenteeism from day care as compared with the other groups; all of the differences were statistically significant (P< .001). None of the regimens were associated with a significantly higher number of emergency department visits (P = .65) or serious long-term complications (P = .66). The drug used for initial loading had no effect on outcome in any of the groups.ConclusionsAn alternating treatment regimen of acetaminophen (12.5 mg/kg per dose) and ibuprofen (5 mg/kg per dose) every 4 hours for 3 days, regardless of the initial loading medication, is more effective than monotherapy in lowering fever in infants and children.

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