Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial.

BMJ (2008)

Alastair D Hay, consultant senior lecturer in primary health care,1 Ce´ire Costelloe, trial coordinator,1
Niamh M Redmond, trial coordinator,1 Alan A Montgomery, senior lecturer in primary care research,1
Margaret Fletcher, reader in children’s nursing,2 Sandra Hollinghurst, senior lecturer in health economics,1
Tim J Peters, professor of primary care health services research1


ABSTRACT
Objective To investigate whether paracetamol
(acetaminophen) plus ibuprofen are superior to either
drug alone for increasing time without fever and the relief
of fever associated discomfort in febrile children managed
at home.

Design Individually randomised, blinded, three arm trial.
Setting Primary care and households in England.
Participants Children aged between 6 months and 6 years
with axillary temperatures of at least 37.8°C and up to
41.0°C.

Intervention Advice on physical measures to reduce
temperature and the provision of, and advice to give,
paracetamol plus ibuprofen, paracetamol alone, or
ibuprofen alone.

Main outcome measures Primary outcomes were the time
without fever (<37.2°C) in the first four hours after the first
dose was given and the proportion of children reported as
being normal on the discomfort scale at 48 hours.
Secondary outcomes were time to first occurrence of
normal temperature (fever clearance), time without fever
over 24 hours, fever associated symptoms, and adverse
effects.

Results On an intention to treat basis, paracetamol plus
ibuprofen were superior to paracetamol for less time with
fever in the first four hours (adjusted difference
55 minutes, 95% confidence interval 33 to 77; P<0.001)
and may have been as good as ibuprofen (16 minutes, −7
to 39; P=0.2). For less time with fever over 24 hours,
paracetamol plus ibuprofen were superior to paracetamol
(4.4 hours, 2.4 to 6.3; P<0.001) and to ibuprofen (2.5
hours, 0.6 to 4.4; P=0.008). Combined therapy cleared
fever 23 minutes (2 to 45; P=0.025) faster than
paracetamol alone but no faster than ibuprofen alone
(−3 minutes, 18 to −24; P=0.8). No benefit was found for
discomfort or other symptoms, although power was low
for these outcomes. Adverse effects did not differ between
groups.

Conclusion Parents, nurses, pharmacists, and doctors
wanting to use medicines to supplement physical
measures to maximise the time that children spend
without fever should use ibuprofen first and consider the
relative benefits and risks of using paracetamol plus
ibuprofen over 24 hours.
Trial registration Current Controlled Trials
ISRCTN26362730.

Uploaded picss....

hi guysss.....FYI...i have uploaded pics of our gathering on last 14th Feb 2009 at Aneka Rasa restaurant....i posted them in my facebook..which i guess most of u already know or by auto ..ur pic will appear in your own album...

am not posting it here as i have experienced slow connection of just uploading fews pics which i always had since my main connection does not fully covered from where am staying...

so ...those with facebook....enjoy ur pics...and one more..i just realized..i did not take more picss that time as am busy with singing and entertaining u guysss....

ok ...ciao...

Announcement on the 14th February 2009 Dinner

To DAEN 2008.....how u people doing??? sure u guys ok ....with works and all....so we decided to have dinner gathering on the said date which will took place in ANEKA RASA (FIRST FLOOR) in Qlap ....Zalin n Seri are responsible for the booking... AS OF 29TH JANUARY 2009...ZALIN JUST CONFIRMED ME ON THE VENUE...WE SHOULD START AROUND SEVEN-ISH....AND COST PER HEAD WILL BE $15.00.....

THEME...all of us if possible should wear in "RED'' ...jgn lupa...theme baju merah!!!!!

to all great voices...bawa2 tah cd ato!!! luah kan tia suara.... FYI as usual ..Diva Nizam will be singing familiar tunes ...think u guys know what i mean...haha...which will follows...Zalin Damit..Liza Taylor...Seri Bungsu...all great singers tooo...


ook...lau ada news i will inform lagi ok... AND ITS ALL SET!!! DONT FORGET BRING YOUR FAVOURITE KARAOKE VCD....