What is the treatment for a 14-year-old patient with influenza A (flu A), presenting with symptoms that started 3 days ago and hyperpyrexia (fever of 103 degrees Fahrenheit)?

From the Guidelines

For a 14-year-old patient with influenza A, presenting with symptoms that started 3 days ago and hyperpyrexia, I strongly recommend starting oseltamivir (Tamiflu) at a dose of 75 mg twice daily for 5 days, as this is the most effective treatment option according to the latest guidelines 1.

Treatment Overview

The patient's symptoms, which started 3 days ago, indicate that antiviral treatment can still provide benefit if started within the first 48-72 hours of illness. The high fever of 103°F suggests significant infection, so supportive care is also crucial.

Medication and Dosage

Oseltamivir is administered orally without regard to meals, although administration with meals may improve gastrointestinal tolerability 1. The recommended dosage for a 14-year-old patient is 75 mg twice daily for 5 days, as outlined in the guidelines 1.

Supportive Care

In addition to oseltamivir, supportive care is essential to manage the patient's symptoms. This includes:

• Giving acetaminophen (Tylenol) 650 mg every 6 hours or ibuprofen (Motrin/Advil) 400 mg every 6 hours as needed for fever and discomfort
• Ensuring the patient stays well-hydrated with plenty of fluids
• Encouraging adequate rest

Monitoring and Precautions

It is essential to monitor the patient for warning signs that would require immediate medical attention, including:

• Difficulty breathing
• Chest pain
• Persistent high fever
• Confusion
• Severe weakness The patient should stay home from school until fever-free for at least 24 hours without fever-reducing medication to prevent spreading the infection to others.

Rationale

Oseltamivir works by inhibiting viral neuraminidase, preventing the release of new virus particles from infected cells, which can reduce the duration and severity of symptoms even when started a few days into the illness 1. The latest guidelines recommend oseltamivir as the first-line treatment for influenza A, and its effectiveness has been demonstrated in reducing the duration of illness and complications in patients with laboratory-confirmed influenza 1.

From the FDA Drug Label

The efficacy of oseltamivir phosphate in preventing naturally occurring influenza illness was demonstrated in a randomized, open-label post-exposure prophylaxis trial in household contacts that included pediatric subjects aged 1 year to 12 years, both as index cases and as family contacts All index cases in this trial received oseltamivir phosphate for oral suspension 30 to 60 mg taken orally once daily for 10 days.

The treatment for a 14-year-old patient with influenza A is oseltamivir phosphate. However, the provided drug labels do not directly address the treatment of a 14-year-old patient.

• The patient's age is above the range (1 year to 12 years of age) of the pediatric subjects in the post-exposure prophylaxis trial.
• The drug labels do provide information on the treatment of adolescents and adults with chronic cardiac or respiratory disease, but the patient in question does not have these conditions. Given the information available, oseltamivir phosphate may be considered for treatment, but the dosage and administration should be determined based on the patient's specific condition and medical history, and under the guidance of a healthcare professional 2 2.

From the Research

Treatment for Influenza A

The treatment for a 14-year-old patient with influenza A (flu A) presenting with symptoms that started 3 days ago and hyperpyrexia (fever of 103 degrees Fahrenheit) can be managed with antiviral medications.

• Oseltamivir is a prodrug of oseltamivir carboxylate, a potent and selective inhibitor of the neuraminidase glycoprotein essential for replication of influenza A and B viruses 3.
• The drug has been shown to be effective in reducing the duration of illness by up to 1.5 days and the severity of illness by up to 38% compared with placebo when initiated within 36 hours of symptom onset 3.
• Treatment with one of four approved anti-influenza drugs, including oseltamivir, may be considered if the patient presents within 48 hours of symptom onset 4.
• The benefit of treatment is greatest when antiviral therapy is started within 24 hours of symptom onset, and it can decrease the duration of illness by about 24 hours in otherwise healthy patients and may decrease the risk of serious complications 4.

Dosage and Administration

• The recommended dosage of oseltamivir for treatment of influenza in children is 2 mg/kg twice daily for 5 days 3.
• The drug can be administered orally, and it is recommended to take it with food to reduce the risk of gastrointestinal side effects such as nausea and vomiting 3, 5.

Efficacy and Safety

• Oseltamivir has been shown to be effective in reducing the duration of symptoms and virus shedding in people with uncomplicated influenza infections, even when treatment was started 48 hours or longer after illness onset 6.
• The emergence of resistance to oseltamivir during treatment is rare, and the drug is generally well-tolerated with mild and transient side effects 3, 6, 5.
• The most common adverse effects of oseltamivir include nausea, vomiting, and headaches, which can be reduced by administering the medication with food 3, 5.