What is the best course of treatment for a patient presenting with fever and body aches?

Treatment of Fever and Body Aches

For patients presenting with fever and body aches, paracetamol (acetaminophen) is the preferred first-line treatment, taken only while symptoms are present, with ibuprofen as an equally effective alternative in most cases. 1

First-Line Pharmacologic Management

Paracetamol (Acetaminophen)

• Paracetamol should be taken if patients have fever and other symptoms that antipyretics would help treat, continuing only while symptoms of fever and body aches are present 1
• The standard dose is 500-1000 mg every 4-6 hours as needed 2
• Until there is more evidence, paracetamol is preferred to NSAIDs for patients with suspected COVID-19 1
• Paracetamol and ibuprofen show equivalent efficacy for fever reduction and symptom relief in upper respiratory tract infections 2, 3

Ibuprofen

• Ibuprofen 400-600 mg is specifically recommended for fever, myalgias (body aches), and headache in patients with flu-like symptoms 4
• The combination of paracetamol 500 mg/ibuprofen 150 mg may be more effective than paracetamol alone for bacterial fever within the first hour 5
• Use the lowest effective dose for the shortest time possible 4, 6

Important Principle: Treat Symptoms, Not Numbers

• Do not use antipyretics with the sole aim of reducing body temperature 1
• Routine fever reduction in critically ill patients has not been shown to improve mortality outcomes 1, 7
• Fever is an evolved defense mechanism that may provide survival benefit 8
• Antipyretics should be used primarily for patient comfort and symptom relief 1, 7

Supportive Care Measures

Patients should be advised to:

• Drink fluids regularly to avoid dehydration (no more than 2 liters per day) 1
• Get adequate rest 4
• Avoid smoking 4
• Consider short-duration topical decongestants if nasal congestion is present 4

Critical Safety Considerations and Contraindications

Paracetamol Precautions

• Monitor for signs of hepatotoxicity (nausea, fatigue, lethargy, jaundice, right upper quadrant tenderness) 6
• Use with caution in patients with liver disease 6

Ibuprofen Contraindications and Warnings

• Contraindicated in patients with aspirin-sensitive asthma (aspirin triad) 6
• Avoid in pregnancy at approximately 30 weeks gestation and later due to risk of premature closure of fetal ductus arteriosus 6
• Between 20-30 weeks gestation, if NSAIDs must be used, limit to lowest dose and shortest duration with ultrasound monitoring if treatment exceeds 48 hours 6
• Increased cardiovascular risk (heart attack, stroke) with higher doses and longer use 6
• Risk of gastrointestinal bleeding and ulceration, especially in elderly, those with prior GI history, or concurrent use of corticosteroids, anticoagulants, SSRIs, or SNRIs 6
• Can reduce effectiveness of ACE inhibitors and interfere with antiplatelet effects of low-dose aspirin 6
• Aspirin is contraindicated in children under 16 years due to risk of Reye syndrome 4

When to Seek Urgent Medical Evaluation

Patients should be instructed to return immediately if they develop:

• Difficulty breathing or painful breathing 4
• Hemoptysis (coughing up blood) 4
• Altered mental status (somnolence, disorientation, confusion) 4
• Fever persisting 4-5 days without improvement or worsening 4
• Signs of serious skin reactions (rash with fever, blistering) 6
• Chest pain, shortness of breath, weakness, or slurred speech suggesting cardiovascular events 6

Diagnostic Workup for Persistent or Severe Cases

If fever and body aches persist or worsen despite treatment:

• Consider chest radiograph to evaluate for pneumonia 1, 7
• Obtain blood cultures if infection is suspected and patient appears seriously ill 1, 7
• Evaluate for specific infectious etiologies based on clinical presentation 1
• Consider non-infectious causes including drug fever, thrombosis, inflammatory conditions 1

Common Pitfalls to Avoid

• Do not treat the thermometer reading rather than the patient's symptoms and comfort level 7
• Do not delay appropriate diagnostic workup while focusing solely on symptomatic treatment 1
• Do not assume fever suppression improves outcomes—it does not reduce mortality 1, 9
• Avoid combining multiple NSAIDs or exceeding recommended doses 6
• Do not use ibuprofen in patients taking low-dose aspirin for cardioprotection without considering timing (aspirin should be dosed at least 2 hours before ibuprofen) 6