What is the recommended treatment for fever and body aches in patients with influenza, particularly regarding the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)?

Treatment of Fever and Body Aches in Influenza Patients: NSAIDs vs. Paracetamol

Paracetamol (acetaminophen) is the preferred first-line treatment for fever and body aches in patients with influenza, while NSAIDs should be used with caution due to potential risks. 1

First-Line Treatment Recommendations

• Paracetamol is recommended as the first-line antipyretic and analgesic for influenza symptoms based on its favorable safety profile 1
• Antipyretics should not be used with the sole aim of reducing body temperature but rather to alleviate symptoms that cause distress 1
• Patients should be advised to take paracetamol if they have fever and other symptoms that would benefit from antipyretic treatment 1
• Treatment should continue only while symptoms of fever and discomfort are present 1

NSAIDs in Influenza Management

• NSAIDs like ibuprofen should be used with caution in influenza patients due to potential risks 1
• Patients with pre-existing asthma may have aspirin-sensitive asthma, which can be associated with severe bronchospasm when NSAIDs are used 2
• Cross-reactivity between aspirin and other NSAIDs has been reported in aspirin-sensitive patients, making NSAIDs potentially dangerous in this population 2
• NSAIDs can mask fever, which may diminish the utility of this diagnostic sign in detecting complications of influenza 2

General Symptomatic Management

• Symptomatic treatment for influenza should include:
  • Treatment of fever, myalgias, and headache with paracetamol or ibuprofen (with caution) 1
  • Rest 1
  • Adequate hydration (drinking plenty of fluids, but no more than 2 liters per day) 1
  • Avoiding smoking 1
  • Consider short-term use of topical decongestants, throat lozenges, or saline nose drops 1

Special Considerations

• For patients with distressing cough, consider short-term use of codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1
• Encourage patients with cough to avoid lying on their back as this makes coughing ineffective 1
• For children under 16 years, aspirin is contraindicated due to the risk of Reye's syndrome 1
• In children over 1 year with cough, honey can be considered as a simple remedy 1

Antiviral Therapy Considerations

• Antiviral treatment (neuraminidase inhibitors) should be considered for patients with:
  • Acute influenza-like illness with fever (>38°C) 1
  • Symptoms for two days or less 1
  • High risk of complications (including chronic medical conditions, immunocompromised patients, children <2 years, adults ≥65 years, and pregnant women) 1
• Oseltamivir 75 mg every 12 hours for five days is the standard adult dosage (reduced by 50% if creatinine clearance is <30 ml/min) 1

Monitoring and Follow-up

• Patients should be advised to re-consult if they develop:
  • Shortness of breath at rest or with minimal activity 1
  • Painful or difficult breathing 1
  • Coughing up bloody sputum 1
  • Drowsiness, disorientation, or confusion 1
  • Fever persisting for 4-5 days without improvement 1
  • Initial improvement followed by recurrence of high fever 1

Evidence Quality and Limitations

• Limited high-quality evidence exists comparing paracetamol and NSAIDs specifically in influenza patients 3
• A randomized controlled trial found that regular paracetamol had no effect on viral shedding, temperature, or clinical symptoms in patients with PCR-confirmed influenza 3
• Both paracetamol and aspirin have shown similar efficacy in reducing fever and symptoms of upper respiratory tract infections in comparative studies 4
• The mechanism of action of paracetamol differs from NSAIDs, potentially explaining its different safety profile 5