Mobile, AL—A recommendation to alternate acetaminophen (ACET) and ibuprofen (IBU) in children with fever is often offered by pharmacists and other healthcare professionals.

A new study in the Journal of the American Pharmacists Association points out that advice to alternate antipyretics, however common, is not backed up by quality evidence.

The research from the Mobile campus of Auburn University’s Harrison School of Pharmacy notes, “Limited efficacy has been demonstrated, but the practice is fraught with potential safety concerns. Many pediatric organizations question the safety of this practice and do not advocate its use.”

Yet it still occurs, and the study specifically looked at  recommendation practices of community pharmacists regarding alternating ACET and IBU in febrile children. Researchers performed a prospective, noncontrolled, descriptive assessment of the pediatric fever recommendations of pharmacists in the Gulf Coast region, with surveys sent to 125 pharmacists. In addition, another 40 pharmacists were randomly chosen to participate in a mock scenario of a child with a fever.

The primary outcome measure was defined as the number of community pharmacists who recommended alternating ACET and IBU, as well as the instructions they provided.

The survey received responses from 56 pharmacists, for a 45% response rate, while 35 pharmacists were involved in the mock scenario, the researchers write. Results from the survey indicate that 82% of pharmacists routinely advise alternating between ACET and IBU. With the mock scenario, meanwhile, 51% of pharmacists recommended alternating the treatments.

The study found that the recommended schedule ranged from every 2 hours to every 6 hours. Most common, the study team determined, was an alternation recommendation of every 4 hours (29%) by the survey respondents and every 3 hours (37%) for the mock scenario participants.

“This study elucidated that most of the participating pharmacists in the Gulf Coast region recommend the practice of alternating ACET and IBU to reduce fever in children,” study authors conclude. “Results show that there is a lack of a standardized schedule for alternating, which can lead to caregiver confusion and the possibility of overdosing.”

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