What is the recommended treatment for symptom management of influenza?

Symptom Management for Influenza

For influenza symptom management, a combination of antiviral therapy (oseltamivir) for eligible patients and supportive care with appropriate antipyretics, cough suppressants, and adequate hydration is recommended. 1

Antiviral Treatment

Eligibility for Oseltamivir

• Recommended for patients with:
  • Acute influenza-like illness
  • Fever >38°C
  • Symptoms for 2 days or less 2

Dosing of Oseltamivir

• Adults: 75 mg twice daily for 5 days
• Children (based on weight):
  • ≤15 kg: 30 mg twice daily

  • 15-23 kg: 45 mg twice daily

  • 23-40 kg: 60 mg twice daily

  • 40 kg: 75 mg twice daily 2

• Dose reduction (75 mg once daily) for patients with creatinine clearance <30 ml/min 2

Timing Considerations

• Earlier treatment provides better outcomes
• Treatment within 12 hours of symptom onset can reduce illness duration by 74.6 hours compared to starting at 48 hours 3
• Treatment may still be beneficial when started after 48 hours in severely ill or immunocompromised patients 2

Supportive Care Measures

Fever and Pain Management

• Acetaminophen: 650-1000 mg every 4-6 hours (maximum 4000 mg/day) for adults
• Children: 10-15 mg/kg/dose every 4-6 hours 1
• Avoid aspirin in children due to risk of Reye's syndrome 2

Cough Management

• Dextromethorphan: 10-30 mg every 4-8 hours for non-productive cough
• Guaifenesin: 200-400 mg every 4 hours for productive cough 1

Nasal Congestion

• Pseudoephedrine: 60 mg every 4-6 hours (use with caution in patients with hypertension, cardiovascular disease, or glaucoma) 1

Hydration and Rest

• Ensure adequate fluid intake
• Rest until fever resolves and symptoms improve 1

Antibiotic Considerations

When to Consider Antibiotics

• Not routinely indicated for uncomplicated influenza 2
• Consider in patients who:
  • Develop worsening symptoms (recrudescent fever or increasing dyspnea)
  • Are at high risk of complications with lower respiratory features
  • Show signs of bacterial pneumonia 2, 1

Antibiotic Selection (if indicated)

• First-line: Co-amoxiclav or a tetracycline (doxycycline)
• Alternative: Macrolides (clarithromycin or erythromycin) for those intolerant to first-line options 2

Special Populations

High-Risk Patients

• More vigilant monitoring for:
  • Elderly (≥65 years)
  • Children <2 years
  • Patients with chronic medical conditions
  • Immunocompromised individuals
  • Pregnant women 1

Hospitalization Criteria

• Temperature >37.8°C
• Heart rate >100/min
• Respiratory rate >24/min
• Systolic blood pressure <90 mmHg
• Oxygen saturation <90%
• Inability to maintain oral intake
• Abnormal mental status 2, 1

Clinical Pearls and Pitfalls

Common Pitfalls

• Delaying antiviral treatment beyond 48 hours significantly reduces efficacy
• Failing to recognize secondary bacterial infections
• Inadequate hydration leading to complications
• Inappropriate use of antibiotics in uncomplicated cases

Monitoring

• Monitor for signs requiring re-consultation:
  • Shortness of breath
  • Painful or difficult breathing
  • Persistent fever for 4-5 days without improvement 1
• For hospitalized patients, monitor vital signs at least twice daily

Expected Benefits of Treatment

• Reduction of illness duration by approximately 24 hours
• Possible reduction in hospitalization risk
• Reduction in subsequent antibiotic use 1, 4
• Decreased incidence of complications such as otitis media, bronchitis, pneumonia, and sinusitis 5

By following these guidelines, most patients with influenza can be effectively managed, reducing symptom duration and preventing complications.