From the Guidelines
Influenza diagnosis and treatment should prioritize antiviral medications like oseltamivir (Tamiflu) for high-risk individuals or severe cases, started within 48 hours of symptom onset, as recommended by the Infectious Diseases Society of America in 2019 1.
Diagnosis and Treatment
Influenza, commonly known as the flu, is a contagious respiratory illness that should be taken seriously. The diagnosis of influenza is typically based on clinical presentation, and treatment should be initiated as soon as possible for high-risk individuals or those with severe symptoms.
High-Risk Groups
High-risk groups for influenza complications include:
- Children younger than 2 years
- Adults 65 years and older
- Persons with chronic medical conditions, such as heart disease, lung disease, or diabetes
- Immunocompromised individuals, including those with HIV infection or taking immunosuppressive medications
- Pregnant women and those within 2 weeks postpartum
Antiviral Treatment
Antiviral medications like oseltamivir (Tamiflu) are recommended for high-risk individuals or those with severe symptoms, and should be started within 48 hours of symptom onset. The typical dosage is 75 mg twice daily for 5 days.
Prevention
Prevention of influenza is crucial, and can be achieved through:
- Annual vaccination with the flu shot, recommended for everyone 6 months and older
- Practicing good hygiene, such as washing hands frequently, covering the mouth and nose when coughing or sneezing, and avoiding touching the face
- Staying home and resting when symptoms occur, to prevent spreading the virus to others
Management of Symptoms
For most cases of influenza, symptoms can be managed with over-the-counter medications, such as:
- Acetaminophen or ibuprofen for fever and pain
- Decongestants for nasal congestion
- Cough suppressants as needed It is essential to stay hydrated by drinking plenty of fluids and to avoid contact with others to prevent spreading the virus. Early antiviral treatment can reduce the risk of complications from influenza, such as pneumonia, respiratory failure, and death, as stated in the Morbidity and Mortality Weekly Report in 2011 1.
From the FDA Drug Label
These examples do not represent an exhaustive list of cross resistance-associated substitutions and prescribers should consider available information from the CDC on influenza drug susceptibility patterns and treatment effects when deciding whether to use oseltamivir phosphate for oral suspension In studies of naturally acquired and experimental influenza, treatment with oseltamivir phosphate for oral suspension did not impair normal humoral antibody response to infection. Two randomized, placebo-controlled, double-blind clinical trials of oseltamivir phosphate were conducted in adults between 18 and 65 years old, one in the U.S. and one outside the U.S., for the treatment of acute uncomplicated influenza. In both trials, there was a 1. 3-day reduction in the median time to improvement in influenza-infected subjects who received oseltamivir phosphate 75 mg twice a day for 5 days compared to subjects who received placebo.
The diagnosis of influenza (flu) is typically based on clinical presentation, including symptoms such as fever, cough, and sore throat, and can be confirmed by laboratory tests. The treatment for influenza includes antiviral medications such as oseltamivir phosphate, which can help reduce the severity and duration of symptoms. Oseltamivir phosphate is recommended for the treatment of acute uncomplicated influenza in adults and children, and has been shown to reduce the median time to improvement in influenza-infected subjects by 1.3 days compared to placebo 2. It is essential to note that the treatment of influenza should be guided by the CDC's recommendations on influenza drug susceptibility patterns and treatment effects. In addition to antiviral medications, supportive care such as rest, hydration, and symptom management can help alleviate symptoms and support recovery. Vaccination is also an essential aspect of influenza prevention and control, and can help reduce the risk of infection and complications.
Key points:
- Diagnosis: Clinical presentation and laboratory tests
- Treatment: Antiviral medications (e.g., oseltamivir phosphate) and supportive care
- Prevention: Vaccination and following CDC recommendations 2
From the Research
Diagnosis of Influenza
- Influenza diagnosis should be considered in critically ill patients admitted with complications such as exacerbation of underlying chronic comorbidities, community-acquired pneumonia, and respiratory failure during influenza season 3
- Molecular tests are recommended for influenza testing of respiratory specimens in hospitalized patients 3
- Antigen detection assays are not recommended in critically ill patients because of lower sensitivity 3
- An endotracheal aspirate (preferentially) or bronchoalveolar lavage fluid specimen (if collected for other diagnostic purposes) should be tested by molecular assay for detection of influenza viruses 3
Treatment of Influenza
- Antiviral treatment with a neuraminidase inhibitor is associated with survival benefit in critically ill adult influenza patients 3
- Standard-dose oseltamivir (75 mg twice daily in adults) for enteric administration is recommended as soon as possible 3
- Oseltamivir reduces the duration of symptomatic illness and hastens the return to normal levels of activity when initiated promptly in patients with naturally acquired influenza 4
- Oseltamivir also reduces the frequency of secondary illnesses and exacerbation of underlying conditions 5
- Earlier initiation of antiviral treatment is associated with the greatest clinical benefit 3
Prevention of Influenza
- Annual influenza vaccination is recommended for all persons aged 6 months and older 3
- Influenza vaccination is estimated to be 50-68% efficacious in preventing pneumonia, hospitalisation or death in nursing home residents 6
- Oseltamivir may be used for seasonal or household prophylaxis, and has been shown to be effective in preventing influenza in unvaccinated otherwise healthy adults and in high-risk populations such as the elderly or those with chronic cardiac or respiratory disease 4
- Antiviral agents, including oseltamivir, zanamivir, amantadine, and rimantadine, may be used for treatment and prophylaxis of influenza 6
High-Risk Patients
- High-risk patients, such as the elderly or those with chronic cardiac or respiratory disease, may benefit from antiviral treatment and prophylaxis 4, 5, 6
- Earlier presentation to care is associated with antiviral treatment in high-risk patients 7
- Fever and earlier presentation to care are associated with antiviral treatment in high-risk patients 7