Can You Give Flu Medications to COVID-19 Positive Patients?
Yes, you can and should give influenza antiviral medications (oseltamivir or baloxavir) to COVID-19 positive patients if they have confirmed or suspected influenza coinfection, as coinfection occurs and treating influenza does not interfere with COVID-19 management. 1
Key Clinical Approach
When to Treat for Influenza in COVID-19 Patients
- Test for influenza coinfection using PCR or rapid testing of nasopharyngeal secretions when influenza is clinically suspected in any COVID-19 positive patient, as coinfection rates of 0.5-2% have been documented 1, 2
- Coinfection is often underdiagnosed unless actively screened, with laboratory-based screening studies identifying more cases than clinical diagnosis alone 2
- Both viruses share similar transmission characteristics and clinical manifestations, making clinical differentiation difficult without testing 2
Treatment Recommendations
For confirmed influenza coinfection:
- Administer oseltamivir or baloxavir according to standard influenza treatment guidelines 1, 3
- Treatment should be initiated as soon as possible after diagnosis, ideally within 48 hours of symptom onset 3
- Continue COVID-19 specific therapies concurrently without modification 1
Antibiotic considerations:
- Consider empirical antibiotics (amoxicillin, azithromycin, or fluoroquinolones) if bacterial superinfection cannot be ruled out, as bacterial coinfection occurs in approximately 40% of viral respiratory infections requiring hospitalization 1
- However, avoid routine antibiotics without clinical justification 4
- Perform comprehensive microbiologic workup before administering empirical antibiotics to facilitate adjustment or discontinuation 4
Important Clinical Nuances
Disease Severity Patterns
- Most reported coinfection cases range from mild to moderate severity, though deaths and mechanical ventilation cases have been documented 2
- COVID-19 generally carries higher long-term morbidity across most organ systems compared to influenza alone, except for pulmonary outcomes where influenza may be worse 5
- Thorax imaging findings typically reflect the dominant viral pathogen, with increasing radiologic experience aiding in differentiation 2
Monitoring During Treatment
- Maintain bispecific antibody or immunosuppressive dosing during influenza prophylaxis if the patient is on such therapies 1
- Monitor for drug interactions, particularly if the patient is on multiple medications 1
- Follow standard isolation protocols for both infections until clinical resolution 1
Common Pitfalls to Avoid
- Do not delay influenza testing in COVID-19 patients with compatible symptoms, as coinfection will remain undiagnosed without active screening 2
- Do not withhold influenza antivirals based solely on COVID-19 diagnosis, as the viruses do not contraindicate each other's treatments 1
- Do not use multiple antiviral drugs simultaneously without clear indication, as this increases toxicity risk without proven benefit 4
- Do not assume all respiratory symptoms are COVID-19 during influenza season; test for both pathogens 2
Symptomatic Treatment
- Over-the-counter medications used for common cold and flu symptoms (antipyretics, cough suppressants, decongestants) are safe and effective for the same symptoms in COVID-19, as the innate immune response mechanisms are similar across respiratory viruses 6
- Paracetamol is preferred over NSAIDs for fever management in COVID-19 until more evidence is available 1