Essential Questions for Patients with Influenza to Ask Their Doctor
Patients with influenza should prioritize asking about antiviral eligibility, warning signs requiring immediate medical attention, and whether they belong to high-risk groups needing closer monitoring or antibiotics.
Questions About Antiviral Treatment
Am I eligible for antiviral medication?
Ask your doctor if you meet the criteria for antiviral treatment. You should receive antivirals if you have fever >38°C, acute influenza-like illness, and have been symptomatic for 2 days or less 1. The standard treatment is oseltamivir 75 mg twice daily for 5 days 1.
Critical timing consideration: Antiviral benefit is greatest when started within 24 hours of symptom onset, though treatment within 48 hours still provides benefit 2.
Special circumstances for antiviral treatment:
- If you're immunocompromised or very elderly: You may still qualify for antivirals even without documented fever 1
- If you're severely ill and hospitalized: You may benefit from antivirals even if started more than 48 hours after symptom onset 1
- If you have kidney disease: Ask about dose adjustment—oseltamivir should be reduced to 75 mg once daily if creatinine clearance is <30 ml/minute 1
Questions About Your Risk Status
Am I in a high-risk group for complications?
Ask specifically if you have any of these conditions that put you at higher risk 1:
- Chronic lung disease: Asthma, COPD, bronchiectasis
- Heart disease: Chronic heart disease, heart failure
- Chronic kidney or liver disease
- Diabetes requiring medication
- Immunosuppression: HIV, cancer, chemotherapy, or steroids equivalent to prednisolone ≥20 mg daily for >1 month
- Neurological conditions with muscle weakness or cerebral palsy
- Pregnancy
- Age ≥65 years
If you're high-risk, you should receive antibiotics if you develop lower respiratory symptoms, even without confirmed pneumonia 1.
Questions About Warning Signs
What symptoms mean I need to return immediately?
Ask your doctor to clarify these danger signs that require urgent reassessment 1:
- Worsening shortness of breath or difficulty breathing
- Chest pain or pressure
- Confusion or altered mental status
- Inability to keep fluids down
- Severe or persistent vomiting
- Return of fever after initial improvement (recrudescent fever)
- Oxygen saturation <90% if you have a home monitor
For children specifically, ask about signs requiring ICU transfer 1:
- Severe respiratory distress with rising respiratory and pulse rates
- Recurrent apnea or irregular breathing
- Evidence of encephalopathy
Questions About Antibiotics
Do I need antibiotics?
Most previously healthy adults with influenza do NOT need antibiotics 1, 3. However, ask if antibiotics are indicated if:
- You're in a high-risk group AND have lower respiratory symptoms 1
- You develop worsening symptoms like recrudescent fever or increasing shortness of breath 1
- There's evidence of bacterial pneumonia on examination or chest X-ray
The preferred antibiotics are co-amoxiclav or tetracycline 1, 3. Clarithromycin or fluoroquinolones are alternatives if you're allergic to penicillin.
Questions About Symptom Management
What can I safely take for symptom relief?
Ask about:
- Fever and pain management: Which medications are safe (note: WHO advises against NSAIDs for severe cases 4)
- Hydration requirements: How much fluid intake is needed
- Nutritional support: Whether you need special dietary considerations if illness is prolonged 1
- Cough suppressants and other symptomatic treatments: What's appropriate for your situation
Questions About Isolation and Transmission
How long should I isolate and what precautions should I take?
Ask specifically about:
- Duration of isolation from work, school, or vulnerable contacts
- Precautions for household members, especially if they're high-risk
- Whether household contacts need prophylactic antivirals: This is conditionally recommended only for those at extremely high risk of hospitalization 4, 5, 6
Questions About Follow-Up Care
When should I follow up and what should I monitor?
Ask about follow-up if you have 1:
- Significant complications during your illness
- Worsening of underlying chronic conditions
- Persistent symptoms beyond expected recovery time
What vital signs should concern me at home?
If you're monitoring yourself, ask which of these warrant contact 1:
- Temperature >37.8°C persisting
- Heart rate >100/min
- Respiratory rate >24/min
- Blood pressure <90 mmHg systolic
- Oxygen saturation <90%
Questions About Comorbid Conditions
How will influenza affect my chronic conditions?
If you have chronic diseases, specifically ask 1, 7:
- COPD or asthma: Whether you need adjustment of inhalers or oxygen therapy guidance
- Heart failure: About fluid management and cardiac monitoring
- Diabetes: About blood sugar monitoring during illness
- Immunosuppression: Whether you need extended antiviral treatment or different monitoring
Ask about disease-specific management plans, as influenza commonly triggers exacerbations of underlying conditions 1, 7.
Questions About Testing
Do I need influenza testing?
Testing is most useful if 7:
- You're high-risk or immunocompromised
- The result will change treatment decisions
- You have pneumonia or severe respiratory illness
- You're being admitted to hospital
Nasopharyngeal specimens are preferred over other collection methods 7, and testing should ideally occur within 4 days of symptom onset.
Common Pitfalls to Avoid
- Don't delay asking about antivirals: The 48-hour window is critical for maximum benefit
- Don't assume you need antibiotics: Most uncomplicated influenza cases don't require them
- Don't ignore worsening symptoms: Recrudescent fever or increasing dyspnea may indicate bacterial superinfection requiring antibiotics 1
- Don't forget to ask about household contacts: High-risk household members may need prophylaxis 4, 5