An evaluation of community pharmacy recommendations regarding alternating antipyretics in children

Alternating antipyretics is a common practice despite a lack of quality evidence to support it. Limited efficacy has been demonstrated, but the practice is fraught with potential safety concerns. Many pediatric organizations question the safety of this practice and do not advocate its use. Nonetheless, many physicians and pharmacists routinely recommend alternating acetaminophen (ACET) and ibuprofen (IBU) in children who are febrile. This study assesses the recommendation practices of community pharmacists regarding alternating ACET and IBU in febrile children.

This was a prospective, noncontrolled, descriptive assessment of the pediatric fever recommendations of pharmacists in the Gulf Coast region: 125 pharmacists were identified and sent surveys. Another 40 pharmacies were randomly chosen to participate in a mock scenario of a child with a fever. The main outcome measure was the number of community pharmacists who recommended alternating ACET and IBU and the instructions given for alternation.

Fifty-six pharmacists responded to the survey (45% response rate), and 35 pharmacists participated in the mock scenario. In the survey, 82% of pharmacists indicated that they routinely recommend alternating between ACET and IBU. In the mock scenario 51% of pharmacists recommended alternating. Of the pharmacists recommending an alternating schedule, the recommended schedule varied widely from every 2 hours to every 6 hours. The most common alteration schedule recommended was every 4 hours (29%) in the survey and every 3 hours (37%) in the mock scenario.

This study elucidated that most of the participating pharmacists in the Gulf Coast region recommend the practice of alternating ACET and IBU to reduce fever in children. Results show that there is a lack of a standardized schedule for alternating, which can lead to caregiver confusion and the possibility of overdosing.