The recent study by Sarrell et al1 on alternating acetaminophen and ibuprofen for fever found significant benefits over monotherapy. Table 2 in their study reports a mean daily temperature approximately 1°C (1.8°F) lower with the alternating regimen. These findings beg to be implemented, but might there be repercussions?
I’m concerned that this approach might be applied to telephone care. The risk for dosage errors and poisoning due to caller confusion remains real on the telephone.2 Telephone medicine is not practiced at research pace. This study had many safeguards: all patients were seen, written instructions on how to dose the 2 antipyretics (including the initial loading dose) were provided, and a pharmacist reinforced these instructions.
Schmitt BD. Concerns Over Alternating Acetaminophen and Ibuprofen for Fever. Arch Pediatr Adolesc Med. 2006;160(7):757. doi:10.1001/archpedi.160.7.757-a