In this ‘Uncertainties’ article in the British Medical Journal, the author looks at whether combinations of paracetamol and ibuprofen are more effective than, and as safe as, monotherapy in children with fever. 

The results of a systematic review are presented – five relevant studies were retrieved however the quality was variable and there were issues with validity which are discussed briefly.  One three-arm open-label trial is ongoing, comparing ibuprofen monotherapy with combined ibuprofen-paracetamol or with alternating ibuprofen-paracetamol.  In addition, guidelines on feverish illness in children from NICE (see link below) mention an ongoing Health Technology Assessment study of combined paracetamol-ibuprofen treatments that is expected to report in 2009.

The author recommends continuing current practice of using either paracetamol or ibuprofen, in view of the uncertainty surrounding superiority or safety of combination antipyretic regimens compared with monotherapy.  It will be interesting to see if the results of the above ongoing studies help to resolve some of the uncertainties.