Latest Guidelines for Managing Influenza
Early antiviral treatment is recommended for all hospitalized patients with suspected or confirmed influenza, those with severe or progressive illness, and individuals at high risk for influenza complications, without waiting for confirmatory test results. 1, 2
Antiviral Treatment Indications
- Treatment should be initiated for hospitalized patients with suspected or confirmed influenza, regardless of illness duration 2
- Treatment is indicated for patients with severe, complicated, or progressive illness attributable to influenza 3, 1
- High-risk patients who should receive treatment include:
- Children <2 years of age 3, 1
- Adults ≥65 years of age 3
- Persons with chronic medical conditions (pulmonary, cardiovascular, renal, hepatic, hematologic, metabolic disorders) 3
- Persons with neurologic and neurodevelopmental conditions 3
- Immunocompromised individuals 3, 2
- Pregnant women and those in the postpartum period (within 2 weeks after delivery) 3
- Persons who are morbidly obese (BMI ≥40) 3
- American Indian/Alaska Native persons 3
- Residents of nursing homes and other chronic care facilities 3
Recommended Antiviral Medications
- Oseltamivir (oral) is the preferred antiviral for most patients, available as capsules and oral suspension 1, 4
- Zanamivir (inhaled) is an alternative for patients without underlying respiratory disease 1, 5
- Baloxavir (oral) is a newer option for treatment of uncomplicated influenza 6
- Peramivir (intravenous) is approved for treatment of acute uncomplicated influenza in children 2 years and older who have been symptomatic for no more than 2 days 1
Timing of Treatment
- Initiate treatment as soon as possible, ideally within 48 hours of symptom onset for maximum efficacy 3, 1
- Treatment should not be delayed while waiting for confirmatory influenza test results, especially in high-risk patients 1, 2
- Even when started after 48 hours, treatment may still provide benefit in patients with severe or progressive disease 3, 1
Oseltamivir Dosing Guidelines
- Adults and adolescents ≥13 years: 75 mg twice daily for 5 days 2
- Children ≥12 months:
- Infants:
Antiviral Chemoprophylaxis Recommendations
- Chemoprophylaxis is recommended in the following situations:
- For high-risk individuals for whom influenza vaccine is contraindicated 3
- For high-risk individuals during the 2 weeks after influenza vaccination, before optimal immunity is achieved 3
- For unvaccinated family members or healthcare personnel with ongoing exposure to high-risk individuals 3
- For control of influenza outbreaks in institutional settings with high-risk individuals 3
- As a supplement to vaccination for immunocompromised individuals who may not respond adequately to the vaccine 3
Efficacy of Antiviral Treatment
- Early treatment with oseltamivir reduces the duration of influenza symptoms by approximately 24-36 hours (26%) 1, 7, 8
- Treatment reduces the risk of otitis media by 34% in children 1
- Antiviral treatment can reduce the risk of complications requiring antibiotics and reduce the risk of hospitalization 2, 7
Side Effects and Precautions
- Vomiting is a common side effect of oseltamivir, occurring in approximately 5% of treated patients 1
- Zanamivir is not recommended for patients with underlying airways disease due to risk of bronchospasm 5
- Despite reports of neuropsychiatric adverse effects with oseltamivir, reviews of clinical trial data have not established a causal link 1
Diagnostic Testing Considerations
- Clinical judgment is important in treatment decisions 1
- Rapid molecular assays are preferred for diagnosis due to their high accuracy and fast results 8
- Negative results from rapid antigen tests should not be used to rule out influenza due to their low sensitivity 1