Recorded sessions on demand will be available 24 hours after the session ends

Abstract Body

Ibuprofen and paracetamol are the antipyretics that can be used in children based on the evidence of their efficiency and safety issues. According to the existing recommendation guidelines concerning the treatment of fever in children, the choice of drug is based on the individual’s characteristics, such as the age of the child, the coexisting clinical conditions and the co-administration of other drugs; whereas a debatable matter concerns the combined or alternate use of the two drugs.
The practice of alternate use of two antipyretics consists of the administration of both drugs at different times of the day, while combined therapy is the concurrent administration of the two drugs. So far, these practices are widely adopted by pediatricians, nurses, pharmacists and childcare providers among different countries. The main concerns that arise from the endorsement of the aforementioned practices are the following:
It has not been proven that they are more efficient to monotherapy in terms of improving the discomfort and the general condition of the child.
There is a risk of dosing errors (overdose or insufficient dosing by the child’s caregivers).
The practise of alternative antipyretics arise from the fever-phobia of parents, and paediatricians seem to enhance the fever-phobia by adopting it.
There are concerns regarding the nephrotoxicity and hepatotoxicity of antipyretics due to the synergy effect of their metabolites.
At present, the alternative/combined administration of two antipyretics is not recommended by the majority of national guidelines with the exclusion of UK-NICE and South Australian CPGs. These two recommendation guidelines encourage the alternate use if the discomfort of the child perseveres or reappears after the administration of one antipyretic agent. Τhe Italian, New Zealand, Canadian and South African guidelines do not recommend this practice in any matter. On the other hand, US guidelines state that the current evidence is poor to endorse or discourage the practise of alternative/ combined antipyretics, and health care providers who adopt this practice should advice parents cautiously in regard to proper formulation, dosing and dosing intervals, and should underline the child’s comfort not the temperature decline.
In conclusion, most experts recommend the use of antipyretic in febrile children with the main goal to lighten the child’s discomfort rather than to reach normothermia. In addition, recent research data analysing the effect of antipyretic treatment on a child’s temperature and discomfort accomplish that evidence is not forceful enough to recommend combined or alternative antipyretic, supporting the majority of existing international guidelines.