From the Guidelines
Oral oseltamivir is the best oral antiviral for influenza, as it should be started as soon as possible and is recommended for 5 days for uncomplicated influenza in otherwise healthy ambulatory patients. According to the clinical practice guidelines by the Infectious Diseases Society of America 1, clinicians should start antiviral treatment as soon as possible with a single neuraminidase inhibitor (NAI), and oral oseltamivir is one of the recommended options. The guidelines also state that clinicians should not routinely use higher doses of US Food and Drug Administration–approved NAI drugs for the treatment of seasonal influenza 1.
Some key points to consider when treating influenza with oral antivirals include:
- Starting treatment as soon as possible 1
- Using a single neuraminidase inhibitor (NAI) such as oral oseltamivir 1
- Treating uncomplicated influenza in otherwise healthy ambulatory patients for 5 days 1
- Considering longer duration of antiviral treatment for patients with immunocompromising conditions or severe lower respiratory tract disease 1
It's essential to note that antiviral treatment should be started promptly, and the choice of antiviral medication may depend on various factors, including the patient's health status and the severity of the illness. However, based on the most recent and highest-quality evidence 1, oral oseltamivir is the recommended oral antiviral for influenza.
From the Research
Oral Antivirals for Influenza
- The most effective oral antiviral for influenza is oseltamivir, as it has been shown to improve survival in mice and reduce the risk of complications in humans 2, 3.
- Oseltamivir has been found to be effective in treating influenza, even when therapy is delayed for up to 5 days after infection with influenza virus 2.
- Combination therapy with oseltamivir and an antibiotic, such as cephalosporin, has been shown to reduce the incidence of secondary bacterial infections and other complications associated with influenza 3.
- Other antiviral agents, such as rimantadine, have been found to be less effective in treating influenza 2.
Antiviral Prescribing Practices
- Antiviral medications are often underprescribed for outpatients with influenza, particularly those at high risk for complications 4, 5.
- Early antiviral treatment (≤2 days since illness onset) is recommended for those with suspected influenza at higher risk for complications, but is often not prescribed in a timely manner 4, 5.
- Factors that influence antiviral prescribing include the patient's presentation to care within 2 days of symptom onset, fever, and the presence of underlying medical conditions 5.
Treatment Outcomes
- Treatment with oseltamivir has been shown to reduce the length of hospital stay, need for ICU admission, and risk of multiple organ failure and respiratory support 3.
- Early initiation of empiric antibiotic therapy in combination with oseltamivir can prevent complications associated with influenza, especially in elderly and unvaccinated high-risk patients 3.