What treatment is indicated for a 17-year-old patient who had influenza a week ago, presented with a clear chest X-ray, and is now complaining of shortness of breath?

From the Guidelines

The patient should be evaluated for potential complications such as pneumonia, acute respiratory distress syndrome (ARDS), or other respiratory issues that may not be immediately visible on a chest X-ray, and antiviral treatment with oseltamivir (Tamiflu) 75 mg orally twice daily for 5 days should be considered, despite the patient being a week into symptoms, if there's a high suspicion of ongoing viral replication or in immunocompromised patients 1.

Recommendation:

• Immediate Assessment: Conduct a thorough clinical assessment including oxygen saturation, complete blood count (CBC), blood cultures, and possibly a repeat chest X-ray or a CT scan of the chest if clinically indicated.
• Oxygen Therapy: Provide supplemental oxygen if the patient's oxygen saturation is below 94% on room air to maintain adequate oxygenation.
• Antiviral Treatment: Consider oseltamivir (Tamiflu) 75 mg orally twice daily for 5 days, as the patient is 17 years old and the recommended dosage for this age group is 75 mg, twice daily 1.
• Supportive Care: Ensure the patient is well-hydrated and consider over-the-counter medications like acetaminophen (Tylenol) 650 mg every 4-6 hours as needed for fever and body aches, not exceeding 4 grams in 24 hours.
• Monitoring: Close monitoring of the patient's respiratory status, including frequent checks of oxygen saturation, respiratory rate, and mental status, is essential, and antiviral treatment should be started as soon as possible after illness onset and should not be delayed while waiting for a definitive influenza test result because early therapy provides the best outcomes 1.

Given the potential for rapid deterioration, especially in high-risk patients, a low threshold for hospital admission should be maintained for close monitoring and further management. The patient's condition should be closely monitored, and treatment should be adjusted according to the patient's response and the severity of the illness.

From the FDA Drug Label

The safety and efficacy of oseltamivir phosphate for the treatment of influenza in pediatric patients 2 weeks old to 17 years of age has been established [see Dosage and Administration (2.2), Clinical Pharmacology (12.3), and Clinical Studies (14. 1)]

The patient is a 17-year-old who had influenza a week ago, and is now complaining of shortness of breath. Oseltamivir phosphate is indicated for the treatment of influenza in pediatric patients 2 weeks old to 17 years of age. However, the patient's current symptoms of shortness of breath are not directly related to the initial influenza infection, and the clear chest X-ray does not provide enough information to determine the cause of the shortness of breath.

• The FDA label does not provide information on the treatment of shortness of breath in patients who have had influenza.
• No conclusion can be drawn regarding the use of oseltamivir phosphate for this patient's current condition. 2

From the Research

Presentation and Diagnosis

• The patient is a 17-year-old who had influenza a week ago and is now complaining of shortness of breath, with a clear chest X-ray.
• The provided studies do not directly address the treatment for a patient with this specific presentation, as they focus on different aspects of shortness of breath, such as diagnosis and management in various contexts 3, 4, 5, 6, 7.

Relevant Studies

• A study from 2016 highlights the importance of considering multiple potential causes of shortness of breath, as a patient's symptoms may not always be indicative of the underlying cause 3.
• Another study from 2023 discusses the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), which may not be directly relevant to this patient's case, given the clear chest X-ray and recent influenza infection 4.
• A 1999 study emphasizes the challenge of determining the etiology of shortness of breath and recommends an evidence-based approach to evaluation 5.
• More recent studies from 2022 and 2025 focus on telephone triage and the importance of considering patients' concerns and uncanny feelings when evaluating shortness of breath, particularly in out-of-hours primary care settings 6, 7.

Treatment Considerations

• Given the lack of direct relevance of the provided studies to the patient's specific situation, it is essential to consider other potential causes of shortness of breath in a 17-year-old patient with a recent history of influenza and a clear chest X-ray.
• Further evaluation and diagnostic testing may be necessary to determine the underlying cause of the patient's symptoms and guide appropriate treatment.