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Alternating antipyretics: is this an alternative?
C E Mayoral1, R V Marino, W Rosenfeld
1Department of Pediatrics, Winthrop University Hopsital, Mineola, New York, USA. kalenamd@aol.com
Pediatrics
|May 3, 2000
Summary
Pediatricians frequently alternate acetaminophen and ibuprofen for fever management, despite lacking scientific evidence of safety or efficacy. This practice, more common in early-career physicians, warrants caution due to potential harm.
Area of Science:
- Pediatric Medicine
- Pharmacology
- Evidence-Based Practice
Background:
- Pediatricians face parental anxiety regarding childhood fevers.
- Current fever management strategies vary widely among practitioners.
- Alternating acetaminophen and ibuprofen is a common but scientifically unvalidated practice.
Purpose of the Study:
- To identify current pediatric fever management strategies.
- To determine the basis for these strategies.
- To assess the frequency of alternating acetaminophen and ibuprofen use.
Main Methods:
- A voluntary 15-item questionnaire was administered to pediatricians during professional meetings.
- 161 completed surveys were analyzed.
- Respondents' practice experience and fever management choices were recorded.
Main Results:
- Most pediatricians initiate antipyretic treatment at 101°F, with some using discomfort as an indicator.
- Fifty percent of respondents advised alternating acetaminophen and ibuprofen.
- Younger physicians (<5 years in practice) were more likely to alternate antipyretics (69.7%).
Conclusions:
- Alternating acetaminophen and ibuprofen for fever is common but lacks scientific evidence for safety and efficacy.
- Cited reasons for this practice include AAP recommendations (erroneously) and peer opinions.
- Caution is advised due to potential harm and the absence of supporting scientific data, especially among newer practitioners concerned about "fever phobia."