Episode 970: Fever Management

Contributor: Aaron Lessen, MD

Educational Pearls:

Recorded March 2025

What is the best treatment for a fever? Tylenol? Ibuprofen? Combined? Alternating the two?

The journal Pediatrics aimed to answer this question with a meta-analysis of 31 randomized controlled trials including 5,009 febrile children.
Results showed that both combined and alternating acetaminophen/ibuprofen regimens were significantly more effective at reducing fever at 4 and 6 hours compared with acetaminophen alone, with numbers needed to treat (NNT) of 3 and 4, respectively.
High-dose ibuprofen alone also offered modest benefit (NNT 8).

What dose should I use?

Oral acetaminophen
- 10 to 15 mg/kg
- Every 4–6 hours as needed
- Do not exceed 75 mg/kg/day (or 4,000 mg/day maximum for older/larger kids)
Oral ibuprofen
- 5 to 10 mg/kg
- Every 6–8 hours as needed
- Do not exceed 40 mg/kg/day (or 2,400 mg/day maximum for older/larger kids)

References

De la Cruz-Mena JE, Veroniki AA, Acosta-Reyes J, Estupiñán-Bohorquez A, Ibarra JA, Pana MC, Sierra JM, Florez ID. Short-term Dual Therapy or Mono Therapy With Acetaminophen and Ibuprofen for Fever: A Network Meta-Analysis. Pediatrics. 2024 Oct 1;154(4):e2023065390. doi: 10.1542/peds.2023-065390. PMID: 39318339.

Summarized by Jeffrey Olson, MS4 | Edited by Jeffrey Olson and Jorge Chalit, OMS4

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