What are the discharge instructions for managing viral illnesses?

From the Guidelines

Discharge instructions for managing viral illnesses should prioritize mask use and hand hygiene to prevent transmission, as well as rest, hydration, and symptomatic relief with over-the-counter medications like acetaminophen or ibuprofen. When managing viral illnesses, it is essential to consider the most recent and highest quality evidence, such as the study published in 2021 1, which provides evidence-based recommendations for nonpharmacological interventions to reduce respiratory viral transmission.

Key measures to include in discharge instructions are:

• Rest at home until fever-free for 24 hours without medication
• Staying hydrated with water and clear fluids
• Taking acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed for fever or pain
• Using saline nasal sprays for congestion and honey or lozenges for sore throat (avoiding honey in children under 1 year)
• Utilizing humidifiers to help with respiratory symptoms
• Practicing hand hygiene with either a nonantimicrobial or antimicrobial soap and water, or an alcohol-based hand rub, especially when hands are visibly dirty or contaminated with blood or other potentially infectious material 1
• Implementing mask use and social distancing to prevent viral transmission, particularly in healthcare settings or when interacting with others who may be at high risk of complications from viral illnesses 1

It is crucial to note that most viral illnesses resolve within 7-10 days without antibiotics, which are ineffective against viruses. Patients should be advised to return to medical care if experiencing difficulty breathing, persistent fever above 103°F (39.4°C) for more than 3 days, severe headache with neck stiffness, persistent vomiting, or worsening symptoms after initial improvement. These measures support the immune system as it naturally fights the viral infection, reducing discomfort while the body clears the virus.

From the FDA Drug Label

Instruct patients to begin treatment with oseltamivir phosphate for oral suspension as soon as possible from the first appearance of flu symptoms, within 48 hours of onset of symptoms. Instruct patients to take any missed doses as soon as they remember, except if it is near the next scheduled dose (within 2 hours), and then continue to take oseltamivir phosphate for oral suspension at the usual times.

The discharge instructions for managing viral illnesses include:

• Starting treatment with oseltamivir phosphate as soon as possible, within 48 hours of onset of symptoms
• Taking any missed doses as soon as remembered, unless near the next scheduled dose
• Continuing to take oseltamivir phosphate at the usual times 2 Key points:
• Begin treatment promptly
• Follow the prescribed dosing schedule
• Be aware of potential interactions with live attenuated influenza vaccine (LAIV) and hereditary fructose intolerance 2

From the Research

Discharge Instructions for Managing Viral Illnesses

• The primary goal of discharge instructions for viral illnesses is to provide patients with the necessary information to manage their symptoms and prevent complications 3.
• Patients with viral illnesses such as influenza should be advised to stay hydrated, rest, and avoid contact with others to prevent transmission 3.
• Antiviral medications may be prescribed for patients with influenza, particularly those who are at high risk of complications or who present within 48 hours of symptom onset 3, 4, 5.
• The choice of antiviral medication depends on various factors, including the patient's age, health status, and the severity of symptoms 4, 5.
• Patients should be educated on the proper use of antiviral medications, including the importance of completing the full course of treatment and potential side effects 6, 5.

Antiviral Medications for Viral Illnesses

• Antiviral medications such as oseltamivir, baloxavir, and umifenovir may be used to treat influenza 4, 5.
• These medications work by inhibiting the replication of the influenza virus, reducing the severity and duration of symptoms 6, 4.
• Baloxavir has been shown to be effective in reducing the risk of hospital admission and alleviating symptoms in patients with non-severe influenza 5.
• Antiviral medications may also be used to treat other viral illnesses, such as herpesviruses and HIV 6.

Special Considerations for Children with Viral Illnesses

• Children with influenza should be treated with antiviral medications if they are at high risk of complications or present within 48 hours of symptom onset 7.
• Clinical testing and underlying conditions are associated with antiviral prescription in children at higher risk of severe influenza 7.
• Strategies to increase antiviral use for children at higher risk for influenza in the emergency department are needed 7.