• Edward Purssell.
• Department of Primary and Intermediate Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK. edward.purssell@kcl.ac.uk
• Arch. Dis. Child. 2011 Dec 1;96(12):1175-9.

ObjectiveTo evaluate the evidence surrounding the use of combinations of paracetamol and ibuprofen in the treatment of fever.DesignSystematic narrative review of randomised controlled trials using the UK Economic and Social Research Council guidance on the conduct of narrative synthesis.SettingInpatient, outpatient and home care.PatientsChildren with fever.Main Outcome MeasuresThe effect of combination treatments of paracetamol and ibuprofen on fever and comfort, and identification of side effects.ResultsSeven studies were identified, six of which provided useful data for the evaluation of the effect of treatment on temperature. Overall these studies showed limited benefit from the combined treatment until around 4 h, after which there was a statistically but only marginally clinically significant benefit. Two studies contained data directly relating to comfort; these suggest a marginal benefit from the combined treatment, but the clinical significance of this was limited. There was no evidence of greater side effects or toxicities associated with the combined treatment. However, it is important to note that these studies were small, short term, and not conducted in the normal setting in which these treatments are given.ConclusionsThere is little evidence of any benefit or harm from the combined treatment compared with the use of each drug alone. In the absence of such benefit, there is little to recommend the unnecessary use of polypharmaceutical methods to treat a symptom that does not require treatment, when effective monotherapies exist.

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