What is the management for fever and throat pain?

Management of Fever and Throat Pain

For acute fever with throat pain, ibuprofen or paracetamol (acetaminophen) are the recommended first-line treatments for symptomatic relief, with ibuprofen showing slightly superior efficacy for pain control, particularly after 2 hours. 1, 2

Initial Assessment and Risk Stratification

Before initiating treatment, apply the Centor criteria to determine the likelihood of bacterial pharyngitis 1:

• Fever by history
• Tonsillar exudates
• Tender anterior cervical adenopathy
• Absence of cough

Score Interpretation:

• 0-2 Centor criteria: Viral etiology most likely; antibiotics are NOT indicated 1, 2
• 3-4 Centor criteria: Consider rapid antigen detection test (RADT) for Group A Streptococcus; if positive, antibiotics may be considered but modest benefits must be weighed against side effects, antibiotic resistance, and costs 1, 2

First-Line Symptomatic Treatment

Analgesic/Antipyretic Selection:

Ibuprofen is preferred over paracetamol for several reasons 1, 2, 3:

• More effective pain relief after 2 hours of administration 2
• Superior antipyretic efficacy in comparative trials 4
• Longer duration of action allowing less frequent dosing (every 6-8 hours vs. every 4 hours for paracetamol) 4
• In bacterial fever specifically, ibuprofen shows faster onset of action at 1 hour 5

Paracetamol (Acetaminophen) is an acceptable alternative 1:

• Equivalent efficacy to ibuprofen in many studies 1, 6
• Comparable safety profile when used at recommended doses 1, 4
• May be preferred in patients with contraindications to NSAIDs 1

Dosing Recommendations:

• Adults: Ibuprofen 400-600 mg or paracetamol 1000 mg 1, 5, 3
• Children: Both agents are equally effective and safe; ibuprofen offers less frequent dosing 1, 2, 4
• Aspirin should be avoided in children due to risk of Reye syndrome 1

What NOT to Use

Avoid these interventions as they lack evidence or have unfavorable risk-benefit profiles:

• Zinc gluconate: Not recommended due to conflicting efficacy and increased adverse effects 1, 2
• Herbal treatments and acupuncture: Inconsistent evidence; not recommended 1, 2
• Routine corticosteroids: Not recommended for routine use 1, 2
  • Exception: May be considered in adults with severe presentations (3-4 Centor criteria) in conjunction with antibiotics, but benefits are minimal (approximately 5 hours pain reduction) 1, 2

Antibiotic Decision-Making

Antibiotics should NOT be prescribed for:

• Patients with 0-2 Centor criteria 1, 2
• Viral pharyngitis (most sore throats are viral) 1, 7
• Prevention of suppurative complications in low-risk patients 1

If antibiotics are indicated (confirmed Group A Streptococcus with 3-4 Centor criteria) 1:

• First choice: Penicillin V, twice or three times daily for 10 days 1, 2
• Penicillin-allergic patients: First-generation cephalosporin (if no anaphylactic history), clindamycin, or clarithromycin for 10 days; azithromycin for 5 days 1
• Avoid broad-spectrum cephalosporins (cefaclor, cefuroxime, cefixime) due to higher cost and increased antibiotic resistance 1

Critical Caveat:

Even with confirmed bacterial pharyngitis, antibiotics provide only modest symptom reduction (shortening illness by approximately 16 hours) and do not prevent suppurative complications in low-risk populations 1, 7. The decision to prescribe must balance this minimal benefit against side effects, microbiota disruption, and antimicrobial resistance 1, 2.

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on purulent discharge alone; discolored nasal discharge reflects inflammation, not bacterial infection 1
• Do not treat asymptomatic carriers of Group A Streptococcus 1
• Do not use topical antibiotics or antiseptics for sore throat; they lack efficacy data 2
• Do not rely on patient or physician perception alone; most sore throats are self-limited viral infections resolving within 7 days without antibiotics 1, 7

Expected Clinical Course

Without antibiotics, acute sore throat typically peaks within 3 days and resolves within 7-14 days 1, 7. Symptomatic treatment with ibuprofen or paracetamol addresses fever and pain while the illness runs its natural course 1, 2, 7.