What medications are recommended for treating flu symptoms?

Medications for Flu Symptoms

For confirmed or suspected influenza, start oral oseltamivir 75 mg twice daily for 5 days as soon as possible, ideally within 48 hours of symptom onset, for all hospitalized patients, those with severe illness, high-risk individuals (including children <2 years, adults ≥65 years, pregnant women, and those with chronic conditions), and consider it for otherwise healthy outpatients. 1, 2

Antiviral Treatment: The Primary Intervention

Oseltamivir (Tamiflu) is the antiviral drug of choice for influenza management across all age groups. 1, 3

Who Should Receive Antivirals

Start antiviral treatment immediately for: 1, 2

• Any hospitalized patient with suspected or confirmed influenza, regardless of illness duration
• Outpatients with severe or progressive illness, regardless of timing
• High-risk patients, including:
  • Children younger than 2 years and adults ≥65 years
  • Pregnant women and those within 2 weeks postpartum
  • Patients with chronic medical conditions (heart disease, lung disease, diabetes, immunosuppression)
  • Immunocompromised patients

For otherwise healthy outpatients, antiviral treatment can be considered if initiated within 48 hours of symptom onset, though the benefit is greatest when started within 24 hours. 1, 2, 4

Dosing Regimens

Adults and adolescents ≥13 years: 1, 3

• Oseltamivir 75 mg orally twice daily for 5 days
• May be taken with or without food (better tolerated with food)

Pediatric patients (weight-based dosing for children ≥12 months): 1, 3

• ≤15 kg: 30 mg twice daily for 5 days

• 15-23 kg: 45 mg twice daily for 5 days

• 23-40 kg: 60 mg twice daily for 5 days

• 40 kg: 75 mg twice daily for 5 days

Infants 0-11 months: 1, 3

• 9-11 months: 3.5 mg/kg per dose twice daily
• 0-8 months: 3 mg/kg per dose twice daily

Alternative Antiviral Options

Zanamivir (inhaled) is an equally acceptable alternative for patients ≥7 years who do not have chronic respiratory disease: 10 mg (two 5-mg inhalations) twice daily for 5 days. 1, 5

Peramivir (IV) can be used for patients ≥2 years who cannot tolerate oral or inhaled medications: single 600 mg IV infusion for adults (12 mg/kg up to 600 mg for children 2-12 years). 1

Baloxavir is an option for patients ≥12 years weighing >40 kg: single oral dose of 40 mg (40-80 kg) or 80 mg (≥80 kg). 1

Expected Benefits of Antiviral Treatment

Timely antiviral therapy provides: 1, 2

• Reduction in illness duration by approximately 24 hours
• Possible reduction in hospitalization rates
• Decreased subsequent antibiotic use
• Faster return to normal activity levels

Symptomatic Treatment

For fever and discomfort, use oral antipyretics such as acetaminophen (paracetamol) or NSAIDs (ibuprofen) with adequate oral hydration. 6, 7, 8

Antipyretic Dosing

Acetaminophen is the first-line antipyretic for all ages (except avoid aspirin in children due to Reye syndrome risk). 2, 7

Ibuprofen or the combination of acetaminophen/ibuprofen can be used, with some evidence suggesting the combination may be more effective for bacterial co-infections. 8

Antibiotic Management: When to Add Antibiotics

Do NOT routinely prescribe antibiotics for previously well adults with uncomplicated influenza or acute bronchitis in the absence of pneumonia. 1, 2

Indications for Antibiotics

Strongly consider antibiotics for: 1, 2

• Patients with influenza-related pneumonia (all require antibiotics)
• Severe disease at presentation with extensive pneumonia, respiratory failure, or hypotension
• Patients who deteriorate after initial improvement, particularly those on antivirals
• High-risk patients (COPD, severe pre-existing illness) with lower respiratory tract features
• Patients failing to improve after 3-5 days of antiviral treatment

Antibiotic selection should cover Staphylococcus aureus in addition to typical community-acquired pneumonia pathogens. Recommended options include doxycycline, co-amoxiclav, or macrolides (clarithromycin preferred over azithromycin for better H. influenzae coverage). 1, 2

Supportive Care

IV fluids should be administered only when clinically indicated for volume depletion in hospitalized patients with severe influenza. 6

Oxygen therapy with monitoring should be provided for hypoxic patients. 6

Critical Pitfalls to Avoid

• Never delay antiviral treatment while awaiting laboratory confirmation—clinical diagnosis is sufficient, and treatment should not be delayed for test results. 1, 2
• Never use aspirin in children with influenza due to the risk of Reye syndrome. 2
• Do not withhold antivirals based on timing beyond 48 hours in hospitalized patients, those with severe illness, or high-risk individuals—they may still benefit. 1
• Remember bacterial co-infection coverage for S. aureus when treating influenza-related pneumonia. 2

When to Seek Immediate Medical Attention

Patients should return immediately if they develop: 6

• Shortness of breath or difficulty breathing
• Bloody sputum
• Drowsiness, disorientation, or confusion
• Fever persisting 4-5 days without improvement
• Initial improvement followed by recurrence of high fever