What are the treatment options for flu symptoms?

Treatment of Flu Symptoms

For uncomplicated influenza symptoms, paracetamol (acetaminophen) is the first-line treatment for fever and body aches, with antiviral therapy (oseltamivir 75 mg twice daily for 5 days) reserved for patients presenting within 48 hours of symptom onset who are at high risk of complications or have severe illness. 1

Symptomatic Management

Antipyretics and Analgesics

• Paracetamol is the preferred first-line agent for fever and body aches based on its favorable safety profile 1
• Ibuprofen may be used with caution as an alternative 1
• Antipyretics should be used to alleviate distressing symptoms rather than solely to reduce temperature 1
• Continue treatment only while fever and discomfort symptoms persist 1
• Aspirin is contraindicated in children under 16 years due to Reye's syndrome risk 1

Additional Supportive Measures

• Rest and adequate hydration (up to 2 liters per day, not exceeding this amount) 1
• Avoid smoking 1
• Short-term topical decongestants, throat lozenges, or saline nose drops for nasal symptoms 1
• For distressing cough: codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution 1
• Honey for children over 1 year with cough 1
• Avoid lying supine when coughing to maintain cough effectiveness 1

Antiviral Therapy

Indications for Treatment

Antivirals should be considered for patients meeting ALL of the following criteria: 2

• Acute influenza-like illness
• Fever >38°C (though immunocompromised or very elderly patients may be treated despite lack of documented fever) 2
• Symptomatic for two days or less 2

High-Risk Patients Warranting Antiviral Treatment

• Chronic medical conditions 1
• Immunocompromised patients 1
• Children <2 years 1
• Adults ≥65 years 1
• Pregnant women 1

Dosing

• Oseltamivir 75 mg every 12 hours for 5 days 2, 3
• Reduce dose by 50% (75 mg once daily) if creatinine clearance <30 ml/min 2
• Treatment reduces illness duration by approximately 24 hours when started within 48 hours of symptom onset 4
• Hospitalized patients who are severely ill may benefit from antiviral treatment started beyond 48 hours, particularly if immunocompromised, though evidence is limited 2

Antibiotic Therapy

Uncomplicated Influenza (No Pneumonia)

• Previously well adults with acute bronchitis do NOT routinely require antibiotics 2
• Consider antibiotics if worsening symptoms develop (recrudescent fever or increasing dyspnea) 2
• High-risk patients should receive antibiotics if lower respiratory features are present 2
• Preferred oral antibiotics: co-amoxiclav or tetracycline 2
• Alternative: macrolide (clarithromycin or erythromycin) or fluoroquinolone active against S. pneumoniae and S. aureus 2

Non-Severe Influenza-Related Pneumonia

• Oral co-amoxiclav or tetracycline preferred 2
• If oral therapy contraindicated: IV co-amoxiclav or second/third generation cephalosporin (cefuroxime or cefotaxime) 2
• Administer antibiotics within 4 hours of admission 2
• Duration: 7 days for uncomplicated pneumonia 2

Severe Influenza-Related Pneumonia

• Immediate parenteral antibiotics after diagnosis 2
• Preferred regimen: IV broad-spectrum beta-lactamase stable antibiotic (co-amoxiclav or cefuroxime/cefotaxime) PLUS macrolide (clarithromycin or erythromycin) 2
• Alternative: fluoroquinolone with enhanced pneumococcal activity plus broad-spectrum beta-lactamase stable antibiotic or macrolide 2
• Duration: 10 days for severe pneumonia; extend to 14-21 days if S. aureus or Gram-negative enteric bacilli suspected or confirmed 2
• Switch to oral regimen when clinical improvement occurs and temperature normal for 24 hours 2

Red Flags Requiring Re-evaluation

Patients should be advised to return if they develop: 1, 4

• Shortness of breath at rest or with minimal activity 1
• Painful or difficult breathing 1
• Coughing up bloody sputum 1
• Drowsiness, disorientation, or confusion 1
• Fever persisting 4-5 days without improvement (suggests bacterial superinfection requiring antibiotic consideration) 1, 4
• Initial improvement followed by recurrence of high fever (recrudescent fever indicates bacterial superinfection) 1, 4

Common Pitfalls

• Do not delay antiviral therapy for laboratory confirmation in high-risk patients presenting within 48 hours 5, 6
• Do not prescribe antibiotics for uncomplicated influenza without evidence of bacterial superinfection 2
• Do not use aspirin in children under 16 years 1
• Fever typically lasts 3-5 days in uncomplicated cases; persistence beyond this warrants reassessment for complications 4
• Immunocompromised, elderly, and pregnant patients may have atypical presentations and warrant closer monitoring even without documented fever 4