What medications would you prescribe for a patient with symptomatic cough due to influenza?

From the Guidelines

For a patient with symptomatic influenza presenting with cough, I recommend starting with oseltamivir (Tamiflu) 75 mg orally twice daily for 5 days, as this antiviral medication works best when started within 48 hours of symptom onset and can reduce the duration and severity of symptoms by inhibiting viral neuraminidase 1.

Medication Rationale

The choice of oseltamivir is based on its efficacy in reducing the duration and severity of influenza symptoms, as well as its safety profile.

• Oseltamivir is recommended for treatment of influenza A and B, and its use is supported by guidelines from reputable organizations, including the Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) 1.
• The dosage of 75 mg orally twice daily for 5 days is consistent with the recommended treatment regimen for adults with influenza 1.

Symptom Management

In addition to antiviral treatment, symptom management is crucial to alleviate the patient's discomfort and improve quality of life.

• Guaifenesin (Mucinex) 600-1200 mg every 12 hours can help thin secretions and improve cough productivity.
• Dextromethorphan 10-30 mg every 4 hours as needed can suppress cough, particularly if it's disrupting sleep.
• Acetaminophen 650 mg every 6 hours (not exceeding 3000 mg daily) is recommended for fever and discomfort.

Additional Considerations

• Adequate hydration is essential to help loosen mucus and prevent dehydration.
• If the patient has underlying conditions like asthma or COPD, they may need their regular respiratory medications adjusted temporarily.
• Antibiotics are not indicated unless there's evidence of secondary bacterial infection.
• Patients should be advised to rest, isolate to prevent transmission, and seek further medical attention if symptoms worsen, particularly if they develop shortness of breath or chest pain.

From the FDA Drug Label

RAPIVAB is an influenza virus neuraminidase inhibitor indicated for the treatment of acute uncomplicated influenza in patients 6 months and older who have been symptomatic for no more than two days Administer RAPIVAB as a single dose within 2 days of onset of influenza symptoms Recommended Dosage: Single Dose Adults and adolescents (13 years and older): 600 mg Pediatric patients (6 months to 12 years of age): 12 mg/kg (up to 600 mg)

For a patient with symptomatic cough due to influenza, peramivir (IV) can be prescribed as it is indicated for the treatment of acute uncomplicated influenza. The recommended dosage is:

• 600 mg for adults and adolescents (13 years and older)
• 12 mg/kg (up to 600 mg) for pediatric patients (6 months to 12 years of age) 2

From the Research

Medications for Symptomatic Cough due to Influenza

The following medications may be prescribed for a patient with symptomatic cough due to influenza:

• Oseltamivir: a neuraminidase inhibitor that can reduce the duration of illness by about 24 hours in otherwise healthy patients and may decrease the risk of serious complications 3
• Zanamivir: a neuraminidase inhibitor that can reduce the frequency of serologically confirmed episodes of influenza 4
• Amantadine: an antiviral drug that can reduce the frequency of flu-like syndromes by about 7% in absolute terms 4

Dosage and Administration

The recommended dosage of oseltamivir is 75 mg twice daily for 5 days, and it should be started within 48 hours of symptom onset 5, 3, 6. Zanamivir and amantadine have different dosing recommendations, and their use should be based on the age of the patient, antiviral activity, side effect profile, ease of administration, drug interactions, and cost 4, 7.

Patient Populations

Oseltamivir may be useful for unvaccinated individuals who are at high risk of infection and severe complications, such as the elderly, young children, and people with underlying chronic disorders 4, 3, 6. The use of antiviral drugs in otherwise healthy adults and children is not generally recommended 4.

Important Considerations

Antiviral drugs are not an alternative to influenza vaccination, but may be a useful adjunct in some situations 4. The benefit of treatment is greatest when antiviral therapy is started within 24 hours of symptom onset 3. The decision to use these agents should be based on the age of the patient, antiviral activity, side effect profile, ease of administration, drug interactions, and cost 7.