In June 2019 researchers from Italy published their review of the medical scientific literature to assess the effectiveness and safety of combined or alternating the use of ibuprofen and paracetamol in children with a high temperature. A total of 9 studies, involving 2,026 children, were included. Results showed that the average temperature was lower in the combined therapy group at 1 hour after the initial administration of therapy although no statistical difference was seen in average temperature at 4 and 6 hours. When compared to children treated with monotherapy, there was a significant difference in the proportion of children reaching normal temperature at 4 and 6 hours with the combined treatment and at 6 hours with alternating treatment. However, the benefit appeared modest and was probably not clinically relevant. The effect on child discomfort and number of doses of medication was modest as well. The researchers concluded that the evidence was not robust enough to encourage combined or alternating paracetamol and ibuprofen instead of monotherapy to treat febrile children and reinforces the current recommendation of most of the international guidelines.
Trippella G et al. Prescribing Controversies: An Updated Review and Meta-Analysis on Combined/Alternating Use of Ibuprofen and Paracetamol in Febrile Children. Front Pediatr. 2019 Jun 5;7:217