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
Erlewyn-Lajeunesse et al14	P 0.95, I 0.92, PI 1.22	No data	No data
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.