小兒發燒：ACT好還是NSAIDs好？

Feverish debate
When you see a young child with a fever, what do you recommend that parents do? Give paracetamol alone, paracetamol and ibuprofen, or ibuprofen alone? This report of a high quality study of 156 children concludes that we should recommend ibuprofen alone.

• Dual therapy (ibuprofen plus paracetamol) reduced fever better than paracetamol alone in the first 24 hours
• But dual therapy was no better than ibuprofen alone in the first 24 hours
• Ibuprofen alone was best at making the child feel better in the first 48 hours

However, a comment says that reduction of fever is of no value if the child does not feel better. Fever helps the body combat infection; antipyretics may prolong the duration of infection, without providing any reduction in fever seizures. So, "we should use ibuprofen if an antipyretic is needed (which is seldom) and not routinely combine paracetamol with ibuprofen."

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Source: Evidence-Bases Medicine 2009;14:174