What are the first-line treatments for relieving influenza symptoms?

First-Line Treatments for Influenza Symptom Relief

For symptomatic relief of influenza, use paracetamol (acetaminophen) or ibuprofen for fever, myalgias, and headache, combined with rest, adequate hydration, and avoidance of smoking. 1, 2

Symptomatic Treatment Approach

Core Symptomatic Medications

• Paracetamol or ibuprofen are the primary agents recommended by the British Infection Society and British Thoracic Society for treating fever, myalgias, and headache in adults with influenza 1, 2
• Use the lowest effective dose for the shortest duration necessary 2
• Taking these medications with food may enhance tolerability 1

Adjunctive Symptomatic Measures

• Rest is recommended as part of comprehensive symptom management 1
• Drinking plenty of fluids helps maintain hydration 1
• Avoiding smoking during illness 1
• Consider short-course topical decongestants, throat lozenges, or saline nose drops for upper respiratory symptoms 1, 2

Critical Pediatric Considerations

• Aspirin is absolutely contraindicated in children under 16 years with influenza due to the risk of Reye's syndrome, a potentially fatal acute encephalopathy with liver dysfunction 2, 1
• Ibuprofen is an appropriate option for treating high fever (>38.5°C) in children with influenza 2, 1

Regarding Tessalon Perles (Benzonatate)

Tessalon Perles are not mentioned in any influenza treatment guidelines as a first-line or recommended therapy. The evidence-based guidelines focus on antipyretics for symptom relief rather than cough suppressants like benzonatate. While benzonatate may suppress cough through a different mechanism than the recommended symptomatic treatments, it lacks guideline support for influenza management.

Antiviral Therapy Integration

While your question focuses on symptom relief, it's critical to understand that oseltamivir (75 mg twice daily for 5 days) is the primary disease-modifying treatment when initiated within 48 hours of symptom onset 3

• Antiviral therapy reduces illness duration by approximately 24 hours and may decrease complications 4
• Greatest benefit occurs when started within 24 hours of symptom onset 5
• Initiation within the first 12 hours can reduce total illness duration by 3.1 days (41%) compared to treatment at 48 hours 5
• High-risk patients (immunocompromised, elderly, pregnant women) should receive early antiviral therapy regardless of symptom duration 2

Warning Signs Requiring Immediate Reassessment

Patients must seek immediate medical attention for: 1, 2

• Shortness of breath at rest or with minimal activity
• Painful or difficult breathing
• Coughing up bloody sputum (hemoptysis)
• Altered mental status (drowsiness, disorientation, confusion)
• Persistent fever for 4-5 days without improvement or with worsening symptoms

Common Pitfalls to Avoid

• Never use aspirin in children or adolescents under 16 years with influenza-like illness due to Reye's syndrome risk 2, 1
• Do not withhold antiviral therapy in high-risk patients while relying solely on symptomatic treatment 2
• Do not delay antiviral treatment beyond 48 hours in eligible patients, as efficacy decreases significantly 5, 4