From the Guidelines
Influenza superinfection should be treated with a dual approach, targeting both the viral influenza infection and the bacterial superinfection, using neuraminidase inhibitors like oseltamivir and empiric antibiotic therapy with a respiratory fluoroquinolone or a beta-lactam plus a macrolide. The most recent and highest quality study, 1, recommends the use of oseltamivir for the treatment of influenza, and the IDSA/ATS 2019 guidelines recommend de-escalation of antibiotics in patients with no evidence of bacterial superinfection and clinical stability after 48 to 72 hours of initiation of antibiotics. Some key points to consider in the treatment of influenza superinfection include:
- The use of neuraminidase inhibitors like oseltamivir, which should be administered at 75mg twice daily for 5 days, ideally within 48 hours of symptom onset, as recommended by 1 and 1.
- The initiation of empiric antibiotic therapy promptly, typically with a respiratory fluoroquinolone like levofloxacin (750mg daily) or a beta-lactam plus a macrolide such as ceftriaxone (1-2g daily) plus azithromycin (500mg daily) for 5-7 days, as recommended by 1 and 1.
- The importance of close monitoring for respiratory deterioration, as superinfection can rapidly progress to severe pneumonia, and the need for supportive care including oxygen therapy, hydration, and fever management, as highlighted by 1 and 1.
- The consideration of newer antibiotics, such as solithromycin, nemonaxacin, delafoxacin, omadacycline, and lefamulin, which have shown promise in the treatment of community-acquired pneumonia, as discussed in 1. Overall, the treatment of influenza superinfection requires a comprehensive approach that takes into account the latest evidence and guidelines, and prioritizes the patient's morbidity, mortality, and quality of life.
From the Research
Influenza Superinfection
- Influenza superinfection refers to a secondary infection that occurs in addition to the primary influenza infection.
- There is limited research directly addressing influenza superinfection, however, studies on influenza treatment and prevention may provide some insights 2, 3, 4, 5, 6.
Treatment and Prevention of Influenza
- Oseltamivir is a neuraminidase inhibitor that has been shown to be effective in reducing the duration and severity of influenza symptoms when initiated promptly 2.
- The combination of oseltamivir with azithromycin has been studied, with some research suggesting it may be beneficial in preventing complications and relieving symptoms quickly 4, while other studies found no additional benefits over oseltamivir monotherapy 5.
- Vaccination is recommended for individuals older than 6 months of age and has been shown to decrease disease severity 6.
Management of Influenza Infection
- Early antiviral therapy and supportive care are the mainstay of treatment for influenza infection 3.
- Treatment should be started as soon as possible, without delay for diagnostic testing results 3.
- Neuraminidase inhibitors, such as oseltamivir, can decrease the duration of influenza and are recommended for hospitalized patients or those with a high risk of complications 6.