Paracetamol, Acetaminophen and Ibuprofen

which Drug to Use for Fever?

There has been a study that has shown that combining paracetamol (or acetaminophen as it is known in North America) and ibuprofen in combination is more effective at treating fever than drugs used individually but there is no evidence on whether symptoms are also reduced more effectively with both drugs used together. No drug is completely without side effects and so the current advice remains that one or other of Paracetamol (Acetaminophen in North America) or Ibuprofen is used first alone, with the option of adding the other in if no response.

My approach is to advise Paracetamol (or Acetaminophen in North America) as first line for fever because overall Ibuprofen, even though it has a good safety profile in children, is more likely to produce side effects than Paracetamol (Acetaminophen). However, as an anti-inflammatory agent for some disorders, such as arthritis, Ibuprofen would be my drug of choice.

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When Should I Treat a Fever?

Having a fever is not a bad thing. It is the way the body treats itself - making the bug uncomfortable. Studies with influenza show that you recover more quickly if you don't have Paracetamol or Acetaminophen as the fever helps the body clear the bug.

For this reason, use drugs to treat fever as little as possible. Don't treat your child just because he has a fever, but use Paracetamol or Acetaminophen if your child is really miserable with the fever. To read more about fever, 

There has been study that shows an association with paracetamol use and asthma in children. This does not mean that paracetamol (acetaminophen in North America) use causes asthma, however there should be caution in using excessive amounts of paracetamol (acetaminophen), and it should only be used when necessary. Treating a temperature just because it's there is not necessary - only treat if your child is miserable with a fever.

My advice for treating fever in children is this:

• only treat if your child is miserable with the fever - don't treat a fever just because it's there
• only treat if the temperature is 38.5 C (101.3 F) or above
• use Paracetamol (Acetaminophen in North America) as the first option, and only add in Ibuprofen is there is no response
• do not use Ibuprofen in chicken-pox
• use drugs in the appropriate doses - see below
• store medications, especially Paracetamol (Acetaminophen) safely

Paracetamol / Acetaminophen

Paracetamol is also known as Pamol and Calpol.
Acetaminophen is also known as Tylenol.

These are the first line medications for infants and toddlers with fever or pain. The doses are the same whichever preparation you use.