What is the appropriate management for a patient presenting with flu-like symptoms?

Management of Flu-Like Illness

For patients presenting with flu-like symptoms, treatment with oseltamivir (Tamiflu) 75 mg twice daily for 5 days is recommended if they present within 48 hours of symptom onset, have fever >38°C, and are over 1 year of age. 1

Initial Assessment

Key Symptoms to Document

• Fever (>38°C in adults, >38.5°C in children)
• Cough
• Sore throat
• Myalgias (muscle aches)
• Headache
• Fatigue
• Possible gastrointestinal symptoms (nausea, vomiting, diarrhea)

Risk Stratification

Identify patients at high risk for complications:

• Age <2 or >65 years
• Chronic medical conditions (cardiac, pulmonary, renal, hepatic, neurological, hematologic)
• Immunocompromised status
• Pregnancy
• Obesity (BMI ≥40)

Treatment Algorithm

Antiviral Therapy

• Initiate oseltamivir if:

  • Symptoms present for ≤48 hours
  • Fever ≥38°C (adults) or ≥38.5°C (children)
  • Patient is ≥1 year of age

• Dosing:

  • Adults and children >24kg: 75 mg twice daily for 5 days
  • Children 15-23kg: 45 mg twice daily for 5 days
  • Children <15kg: 30 mg twice daily for 5 days
  • Reduce dose by 50% if creatinine clearance <30 ml/min 2, 1

• Benefits of early treatment:

  • Reduction of illness duration by approximately 24 hours
  • Possible reduction in hospitalization rates
  • Reduction in subsequent antibiotic use 2
  • Earlier initiation (within 24 hours) provides greater benefit in symptom reduction 3

Antibiotic Therapy

• Do not routinely prescribe antibiotics for uncomplicated influenza without evidence of bacterial co-infection 2, 1

• Consider antibiotics for:

  • Patients with significant worsening of symptoms (recrudescent fever, increasing dyspnea)
  • Patients with COPD or other severe pre-existing illnesses
  • Patients with signs of pneumonia 2

• If antibiotics indicated, use:

  • First-line: Co-amoxiclav or doxycycline
  • Alternative: Clarithromycin or erythromycin (if intolerant to first-line options) 2, 1

Symptomatic Treatment

• Acetaminophen for fever >38.5°C and pain relief
• Adequate hydration
• Rest until fever resolves
• Cough suppressants for non-productive cough

Monitoring and Follow-up

Signs of Improvement

• Temperature <37.8°C for at least 24 hours
• Heart rate <100/min
• Respiratory rate <24/min
• Systolic blood pressure >90 mmHg
• Oxygen saturation >90% 1

Warning Signs Requiring Reassessment

• Difficulty breathing or shortness of breath
• Pain or pressure in chest
• Sudden dizziness or confusion
• Severe or persistent vomiting
• Symptoms that improve but then return with fever and worse cough 1

Special Considerations

Severe Disease

Indicators of severe disease requiring hospital referral:

• Respiratory distress
• Hypoxemia (O2 saturation <90%)
• Rising respiratory and pulse rate with clinical evidence of respiratory distress
• Altered mental status 2

Common Pitfalls to Avoid

1. Delayed antiviral initiation - Starting treatment within 24 hours of symptom onset provides maximum benefit 3
2. Unnecessary antibiotic use - Reserve for suspected bacterial co-infection
3. Inadequate risk stratification - Carefully assess patients for risk factors for complications
4. Incomplete treatment course - Emphasize importance of completing full 5-day course of antivirals
5. Overlooking nausea as a side effect - Taking oseltamivir with food can reduce nausea and vomiting 2, 4

Documentation in SOAP Format

• Subjective: Document onset, duration, and severity of symptoms
• Objective: Vital signs (temperature, heart rate, respiratory rate, blood pressure, O2 saturation)
• Assessment: Influenza-like illness, severity assessment, risk factors for complications
• Plan: Antiviral therapy if indicated, symptomatic management, return precautions, follow-up plan

Remember that while annual influenza vaccination remains the best preventive measure, prompt antiviral treatment can significantly reduce the duration and severity of illness when initiated early after symptom onset 5.