Combined antipyretictherapy: Another potential source of chronicacetaminophen toxicity

The Journal has recently published 2 articles and an editorial that discussed mortality from chronic acetaminophen toxicity in children.[1] [3] The Poison Center has recently encountered an innovative way in which a pediatricianis instructions can produce confusion and potentially lead to acetaminophen or ibuprofen intoxication. Six calls to our center from May 1, 1997, through February 20, 1998, alerted us that parents had been instructed by their pediatricians to administer acetaminophen for fever, and if the temperature had not responded in 2 hours, to administer ibuprofen. The parents called because they were confused about the instructions and times of administration of these 2 medications. Although none of these cases resulted in toxicity, we are concerned about the concept and the potential for drug intoxication and interactions. Similar instructions have been written on medication order sheets of children in the hospital.