Fever and Chills: Management

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Managing fever and chills

Here we discuss how to manage the symptoms of fever and chills as a result of the flu infection.

Steps for managing fever and chills

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By asking appropriate diagnostic questions, confirm the fever and chills are due to the flu.

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  • Increase patient awareness on how to minimise transmission of the flu to other people
  • Advise on the warning signs associated with fever that may require further assessment by a physician
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Along with appropriate advice, recommend or provide treatments to suit the individual needs of your patient.

Patient and clinician

Educating your patients

As the influenza virus causes significant illness and even morbidity every year,1 patients should be educated on reducing their risk of becoming infected, and how to help stop the spread of the virus. This includes:2

  • Using a tissue to cover coughs and sneezes
  • Regularly and thoroughly washing hands
  • Avoiding touching the face
  • Keeping up to date with yearly vaccinations
  • Maintain good hydration
  • Rest

It should also be explained that there is no cure for the flu, but bothersome symptoms such as fever and chills can be managed with both pharmacologic3 and non-pharmacologic therapies.4

Treatment of fever should be focused on alleviating discomfort, not just lowering temperature5

  • Non-pharmacologic therapies


    Non-Pharmacologic Measures of Alleviating Fever

    • Drink plenty of fluids to prevent dehydration
    • Regularly monitor symptoms
    • Keep the environment at a neutral temperature, around 25°C
    • Avoid overdressing or underdressing; wear whatever is comfortable
    • Avoid sponge baths as this does not provide additional benefit4
    • Ensure you rest
  • Pharmacologic therapies

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    Pharmacologic Measures of Alleviating Fever

    The main oral analgesics and antipyretics available from pharmacies without a prescription, are paracetamol and NSAIDs (ibuprofen and aspirin).5

    Paracetamol has been clinically proven to relieve fever5-8 as a symptom of the flu, and is considered the first-line therapy of choice in both adults and children.5,9

    Ibuprofen is also appropriate for use in children >3 months of age,10 but is associated with more frequent adverse events and drug interactions compared to paracetamol.11 Aspirin-containing products are not recommended for treatment of fever in paediatric populations (due to Reye’s syndrome).4

Female clinician

Fever and chills requiring referral

Fever and associated chills are reported symptoms of various illnesses and are not exclusive to the flu.

The patient should immediately be referred to a doctor if any of the following is observed by the pharmacist or reported by the caregiver:

  • Pallor, mottling, ashen or blue colour of the skin, lips, or tongue
  • Failure to respond to social cues
  • Difficulty waking or staying awake
  • Decreased activity
  • Signs of respiratory distress, such as nasal flaring, increased respiratory rate, crackles in chest, grunting, or moderate to severe chest indrawing
  • Fast heart rate
  • Reduced skin turgor
  • Age 3-6 months with a temperature greater than 39°C, or age < 3 months with a temperature greater than 38°C12
  • Fever with a rash
  • Flu-like symptoms that improve but then recur with fever and a worse cough13
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Fever and chills management: in summary

After appropriate diagnosis of the flu as the underlying cause of your patient’s fever and chills, they may be recommended analgesics/antipyretics for symptomatic relief, with paracetamol suggested as the first-line therapy.5,9

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