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Major literature sourcesUpdate of the 2009 Italian Pediatric Society Guidelines about management of fever in children. (Clin Ther. 2012;1648-1653)Feverish assessment in children : assessment and initial management in children younger than 5 years. NICE National Institute of Clinical Excellence May 2013)

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NICE:Do not routinely use the rectal route in children 0-5 yearsAxillary measurement using a digital thermometer is recommended Italian guidelines: Axillary measurement using a digital thermometer is recommended.

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NICE:Do not give both agents simultaneouslyOnly consider alternating these agents if the distress persists or recurs before the next dose is due (2013)

Italian guidelines:There are a number of concerns about combined therapy, in particular possible renal toxicity caused by the additive and possible synergistic effects of drug metabolites in children with dehydration, misdosing and increased parental concerns about fever.Combined or alternating use of ibuprofen and paracetamol is not recommended (2012)

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Supported by Reckitt Benckiser Healthcare Suppositories of Ibuprofen: 60 mg, 125 mg456 children232 males224 femalesAge:1.951.5 yearsDuration of treatment:2.091 (1-8) daysNumber of doses:2.41.4 (1-10) doses

Premarketing surveillance of ibuprofen suppositories (Nurofen) in febrile children: A multi center study. Clinical Pediatrics 2011;50(3):196-9.36 children received also oral ibuprofenParental satisfaction: 4.231 (out of 5)410 (90%) parents ranked 4-5 (out of 5)17 (3.7%) cases of adverse effects:5 diarrhea, 5 rash, 4- rectal burning, 3 shivering

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