From the Guidelines
The patient should be evaluated for a potential infectious cause and managed symptomatically.
Recommended Treatment
- Recommend paracetamol (Tylenol) 650-1000mg every 4-6 hours as needed for fever and body aches, not to exceed 4000mg in 24 hours 1.
- Encourage the patient to stay hydrated by drinking plenty of fluids, such as water or electrolyte-rich beverages like sports drinks, but no more than 2 litres per day 1.
- Rest and avoid strenuous activities until symptoms improve.
- Consider ibuprofen for antipyretic use, but only if the temperature is higher than 38.5 ℃, and no more than 4 times in 24 hours 1.
Monitoring and Follow-up
- If the patient's symptoms worsen or last longer than 3-5 days, or if they experience difficulty breathing, chest pain, or severe headache, they should seek immediate medical attention.
- If the patient has a history of certain medical conditions or is taking medications that may compromise their immune system, they should consult their healthcare provider for further guidance.
Additional Considerations
- Provide general advice and symptomatic treatment, including addressing individual concerns and expectations, and providing information about the illness and self-help measures 1.
- Consider the use of other medications, such as topical decongestants, throat lozenges, and saline nose drops, as needed 1.
From the FDA Drug Label
Stop use and ask doctor if • pain gets worse or lasts more than 10 days • fever gets worse or lasts more than 3 days • new symptoms occur • redness or swelling is present These could be signs of a serious condition.
The next step for a patient presenting with fever, asthenia, and myalgia is to ask a doctor if the symptoms persist or worsen, as they could be signs of a serious condition 2.
From the Research
Evaluation of Fever
The patient presenting with fever, asthenia, and myalgia requires a thorough evaluation to determine the underlying cause of their symptoms. According to 3, fever can be due to infectious or non-infectious etiology and results from the body's natural response to a pyrogen.
Differential Diagnosis
The differential diagnosis for fever is broad and includes:
- Infectious etiologies
- Malignancies
- Noninfectious inflammatory disease
- Miscellaneous causes such as venous thromboembolism and thyroiditis 4
- Occult sources of infection and conditions that mimic sepsis, such as musculoskeletal, cardiac, neuraxial, and abdominal sources of sepsis 5
Initial Evaluation
The initial evaluation should include:
- A comprehensive history and physical examination to help narrow potential etiologies 4
- Adjunctive testing, such as C-reactive protein, erythrocyte sedimentation rate, and procalcitonin, although these tests do not have the needed sensitivity and specificity to definitively rule in a bacterial cause of fever 3
- Blood cultures should be obtained in septic shock or if the results will change clinical management 3
Further Testing
If the initial evaluation is unrevealing, further testing may include:
- 18F fluorodeoxyglucose positron emission tomography scan, with computed tomography, to help reach a diagnosis 4
- Tissue biopsy, such as liver, lymph node, temporal artery, skin, skin-muscle, or bone marrow biopsy, due to the relatively high diagnostic yield 4
Consideration of Sepsis Mimics
It is essential to consider sepsis mimics, such as neuroleptic malignant syndrome, malignant hyperthermia, medication toxicity, and thyroid storm, in patients who fail to respond to standard therapies for sepsis 5.
Infection Prevention
When caring for patients with suspected or known infectious diseases, such as COVID-19, healthcare personnel should follow evidence-based guidelines for infection prevention, including the use of personal protective equipment (PPE) 6.