From the Guidelines
Inpatient influenza treatment should be started as soon as possible for hospitalized patients with documented or suspected influenza, regardless of illness duration prior to hospitalization.
Guidelines for Inpatient Influenza Treatment
- Antiviral treatment should be initiated for adults and children with documented or suspected influenza who are hospitalized, regardless of illness duration prior to hospitalization 1.
- The treatment schedule for Oseltamivir is 75 mg every 12 hours for five days, with a reduced dose of 75 mg every 24 hours for patients with creatinine clearance less than 30 ml/minute 1.
- Hospitalized patients who are severely ill, particularly if also immunocompromised, may benefit from antiviral treatment started more than 48 hours from disease onset, although there is no evidence to demonstrate benefit or lack of it in such circumstances 1.
- High-risk patients, including those with chronic medical conditions, immunocompromised patients, children younger than 2 years, adults ≥65 years, pregnant women, and those within 2 weeks postpartum, should also be treated with antivirals 1.
- Antiviral treatment can be considered for outpatients who are not at high risk of influenza complications, but the decision to treat should be made on a case-by-case basis 1.
From the Research
Inpatient Influenza Treatment Guidelines
The guidelines for inpatient influenza treatment are as follows:
- Supportive care is crucial in managing influenza, particularly in optimizing respiratory failure through established ventilatory strategies 2
- Noninvasive ventilation and high-flow nasal oxygen may have a limited role in selected patients under carefully monitored circumstances 2
- Drug therapy, such as neuraminidase inhibitors (NAI), exerts a modest clinical effect and should be used as early as possible in critically ill patients 2, 3, 4
- Oseltamivir is a recommended treatment option, and its effects on mortality and other outcomes are being studied 2, 3, 4, 5, 6
- Steroid therapy is not recommended in the absence of another indication, as it may increase mortality 2
Treatment Options
- Neuraminidase inhibitors, such as oseltamivir, peramivir, and zanamivir, are approved anti-influenza drugs that may be considered for treatment 3, 4, 6
- The benefit of treatment is greatest when antiviral therapy is started within 24 hours of symptom onset 3, 6
- Annual influenza vaccination is recommended for all people six months and older who do not have contraindications 3, 6
Diagnostic Approaches
- Rapid molecular assays are the preferred diagnostic tests for influenza, as they are highly accurate and have fast results 3, 5
- Laboratory testing may be useful in hospitalized patients with suspected influenza and in patients for whom a confirmed diagnosis will change treatment decisions 3, 5
- Point of care tests, such as CLIA-waived tests, can allow for rapid diagnosis and treatment of influenza 5