Is the treatment plan for Influenza A (Oseltamivir (oseltamivir phosphate)), Acute allergic rhinitis (Xyzal (levocetirizine)), and Allergic conjunctivitis (Zaditor (ketotifen)) with Dexamethasone (dexamethasone) acceptable?

Treatment Plan Assessment for Influenza A with Allergic Conditions

The treatment plan is largely appropriate, but the dexamethasone 8 mg IM injection is NOT recommended for routine allergic rhinitis and conjunctivitis management, as systemic corticosteroids should be reserved for severe allergic conditions and carry unnecessary risks when effective topical alternatives exist. 1

Influenza A Management - APPROPRIATE

Oseltamivir 75 mg PO twice daily × 5 days is the correct treatment for influenza A when initiated within 48 hours of symptom onset. 1, 2

• This regimen reduces illness duration by approximately 24 hours and may decrease hospitalization rates and secondary complications. 3, 4
• The supportive care measures (hydration, rest, warm fluids) are appropriate and align with guideline recommendations. 5, 6
• Monitoring for worsening symptoms (shortness of breath, high fever, chest pain) is essential, particularly watching for unstable clinical factors like respiratory rate >24/min, oxygen saturation <90%, or inability to maintain oral intake. 1, 5, 2

Important caveat: Dose adjustment to 75 mg once daily is required if creatinine clearance is <30 ml/min. 1, 6

Allergic Rhinitis Management - APPROPRIATE

Switching to Xyzal (levocetirizine) 5 mg PO daily is a reasonable choice for allergic rhinitis management. 7

• Levocetirizine is a selective, potent H1 receptor antagonist with rapid onset, long duration of action, and superior efficacy compared to other second-generation antihistamines in allergen challenge studies. 7
• Allergen avoidance and saline nasal spray PRN are appropriate adjunctive measures. 1, 8

Allergic Conjunctivitis Management - APPROPRIATE

Zaditor (ketotifen) eye drops 1 drop both eyes twice daily is an excellent choice for allergic conjunctivitis. 1

• Ketotifen is a dual-action agent with both antihistamine and mast cell stabilizer properties, providing rapid onset (within 30 minutes) and suitable for both acute and long-term treatment. 1
• Cold compresses PRN are appropriate supportive measures. 1

Dexamethasone 8 mg IM - NOT RECOMMENDED

The systemic corticosteroid injection is inappropriate for routine allergic rhinitis and conjunctivitis management. 1

Why this is problematic:

• For ocular symptoms: Ocular corticosteroids should be reserved for more severe symptoms of allergic conjunctivitis due to vision-threatening side effects including cataract formation, elevated intraocular pressure, and secondary infections. 1
• For nasal symptoms: Intranasal corticosteroids are the preferred route for allergic rhinitis when corticosteroids are needed, not systemic administration. 8
• Systemic effects: An 8 mg IM dose carries unnecessary systemic corticosteroid risks (hyperglycemia, immunosuppression, mood changes) when topical alternatives are equally or more effective. 1

Better alternatives if additional anti-inflammatory control is needed:

• For nasal symptoms: Add intranasal corticosteroid spray (e.g., fluticasone, mometasone) which provides targeted anti-inflammatory effects without systemic exposure. 8
• For ocular symptoms: The prescribed ketotifen is already appropriate; if inadequate, consider loteprednol etabonate (Alrex), a modified steroid with greatly reduced risk of elevated intraocular pressure. 1

Antibiotic Consideration

Antibiotics are NOT indicated at this time. 1, 5, 2

• Previously well adults with acute bronchitis complicating influenza, in the absence of pneumonia, do not routinely require antibiotics. 1, 2
• Consider antibiotics only if the patient develops worsening symptoms (recrudescent fever or increasing dyspnea) or shows evidence of bacterial pneumonia. 1, 2