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Ibuprofen and paracetamol are equally effective1 and widely used antipyretic agents in paediatric practice. There is no evidence to support the concept that treating a fever with antipyretics, paracetamol, or ibuprofen, will prevent febrile convulsions.2 Ibuprofen is available over the counter and is used in addition to or instead of paracetamol both in hospital and community settings. It is advertised on television. There is an increasing trend to routinely prescribe both drugs for children specifically to manage fever. Although it is considered to be a reasonably safe drug,3 there are reports of nephrotoxicity,4,5 including renal failure when ibuprofen is administered to volume depleted children.6
A previously well, 18 month old, 10.5 kg boy presented with a four week history of intermittent cough and wheeze. In the week prior to admission he developed a fever, increasing lethargy, anorexia, and refusing to drink adequately. His fever was initially treated with paracetamol (5 ml …
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