What is the recommended management for a 39-year-old patient diagnosed with influenza?

Management of Influenza in a 39-Year-Old Patient

For a 39-year-old patient with influenza, supportive care is the mainstay of treatment, with antiviral medications (oseltamivir 75 mg twice daily for 5 days) recommended only if symptoms have been present for 48 hours or less.

Initial Assessment and Diagnosis

• Influenza presents with acute, sudden onset of respiratory infection characterized by at least two of:

  • Fever (38-41°C)
  • Cough
  • Headaches
  • Myalgias 1

• Physical examination findings may include:

  • Flushed skin
  • High fever
  • Post-nasal discharge
  • Mild cervical lymphadenopathy
  • Chest examination usually unremarkable 2

Treatment Approach

Supportive Care (First-line)

• Ensure adequate hydration and rest
• Provide appropriate analgesia:
  • Acetaminophen (650-1000 mg every 4-6 hours, maximum 4000 mg/day) 1
  • Do not give aspirin due to risk of Reye Syndrome 2, 1
• Symptomatic relief:
  • Dextromethorphan (10-30 mg every 4-8 hours) for non-productive cough
  • Guaifenesin (200-400 mg every 4 hours) for productive cough
  • Pseudoephedrine (60 mg every 4-6 hours) for nasal congestion 1

Antiviral Therapy

• Consider antiviral treatment if:

  1. Symptoms present for ≤48 hours
  2. Fever (>38°C)
  3. Acute influenza-like illness 2

• Recommended regimen:

  • Oseltamivir 75 mg orally twice daily for 5 days 2, 1, 3
  • Dose reduction needed if creatinine clearance <30 ml/minute 3

• Benefits of antiviral therapy:

  • Decreases duration of illness by approximately 24 hours
  • May reduce risk of complications 4
  • Greatest benefit when started within 24 hours of symptom onset 4

Antibiotic Therapy

• Previously well adults with acute bronchitis complicating influenza, in the absence of pneumonia, do not routinely require antibiotics 2

• Consider antibiotics only if:

  1. Worsening symptoms (recrudescent fever or increasing dyspnoea)
  2. Patient at high risk of complications with lower respiratory features 2

• If antibiotics indicated, preferred choices:

  • Doxycycline or co-amoxiclav 2
  • Alternative: Clarithromycin or erythromycin (if intolerant to first-line options) 2

Monitoring and Follow-up

• Monitor for complications:

  • Secondary bacterial pneumonia (suspect if after initial improvement, fever recurs with purulent sputum)
  • Exacerbation of underlying conditions (asthma, COPD)
  • Rare complications: myocarditis, encephalitis, myositis 2

• Consider follow-up if:

  • Patient has significant comorbidities
  • Symptoms worsen after 48-72 hours
  • New symptoms develop suggesting complications 2

Prevention Measures

• Advise patient about infection control:

  • Practice respiratory and hand hygiene
  • Remain isolated from others while infectious (approximately 5 days after symptom onset)
  • Cover coughs and sneezes with tissues 2, 1

• Recommend annual influenza vaccination for future seasons 4

Special Considerations

• At 39 years old, this patient is not in a high-risk age group (very young or elderly)
• However, assess for other risk factors that might warrant more aggressive management:
  • Pregnancy
  • Chronic medical conditions (respiratory, cardiac, renal disease)
  • Immunosuppression 2, 5

Common Pitfalls to Avoid

1. Delaying antiviral treatment beyond 48 hours of symptom onset significantly reduces effectiveness
2. Prescribing antibiotics unnecessarily for viral illness without evidence of bacterial co-infection
3. Failing to recognize deterioration or development of complications requiring escalation of care
4. Using aspirin for fever control, especially in younger patients 2, 1