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Arch Dis Child 96:1175-1179 doi:10.1136/archdischild-2011-300424
  • Drug therapy

Systematic review of studies comparing combined treatment with paracetamol and ibuprofen, with either drug alone

Table 3

Summary of outcome measures

Study Temperature Side effects Comfort
Lal et al9 Insufficient data Slightly raised SGPT, SGOT, urea and creatinine in mixed group. No clinical significance No data
Erlewyn-Lajeunesse et al14 Mean fall over 1 h °C (t) No clinically or statistically significant difference No data No data
P 0.95, I 0.92, PI 1.22
Nabulsi et al13 % Afebrile at 6–8 h (r) greater in mixed group No serious adverse reactions. No sign of GI, hepatic, renal toxicity No data
6 h: I 57.6, PI 83.3, p=0.018
7 h: I 45.2, PI 86.1, p<0.001
8 h: I 35.5, PI 80.6, p<0.001
Max temperature decline no difference
Sarrell et al11 Mean max temperature on days 1–3 °C (r) lowest in mixed group, highest in paracetamol No differences in renal and liver values and no abnormalities at 14 days NCCPC score and repeat dosages on days 1–3 lower in mixed group, highest in paracetamol group
1 day: P 40.6, I 40.6, PI 39.6 p<0.001
2 day: P 39.7, I 39.7, PI 38.8 p<0.001
3 day: P 39.3, I 39.6, PI 38.5 p<0.001
Hay et al10 Minutes without feverfirst 4 h (a): greatest in mixed group, shortest in paracetamol group Diarrhoea, vomiting, rash, cough, cold to touch, admitted to hospital no differences and none considered to be related to study No discomfort at 48 h, pairwise comparisons no difference
P 116.2, I 156, PI 171.1
Pairwise comparisonmixed vs paracetamol p<0.001, ibuprofen vs paracetamol p=0.001
First 24 h: same pattern
P 940.3, PI 1055.2, PI 1217.4
Kramer et al12 Mean temperature at 3–6 h °C (o/r)no difference at 3 or 6 h, at 4 and 5 h lower in mixed group No side effects prevented administration and did not differ between groups Repeat dosages needed at 3 and 4 h no difference
4 h: P 38, PI 37.4, p=0.05
5 h: P 37.9, PI 37.1, p=0.003
Paul et al15 Mean temperature at 1–6 h °C (ta) no difference at 1–3 h, at 4–6 h lower in mixed (PI) and alternating (IP) than ibuprofen (note order of groups) Did not evaluate effect of multiple doses or adverse events that could occur from this No data
4 h: IP 36.9, I 37.5, PI 36.9, p=0.002
5 h: IP 36.8, I 38, PI 36.9, p<0.001
6 h: IP 36.9, I 38.5, PI 37.2, p<0.001
  • a, axilla; I, ibuprofen; GI, gastrointestinal; NCCPC, non-communicating children's pain checklist; o, oral; P, paracetamol; PI/IP paracetamol and ibuprofen; r, rectal; SGOT, serum glutamic oxaloacetic transaminase; SGPT, serum glutamic pyruvic transaminase; t, tympanic; ta, temporal artery.

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