What are the discharge instructions for a patient with influenza B infection?

From the Guidelines

Patients with influenza B should remain isolated at home until they have been fever-free for at least 24 hours without using fever-reducing medications like acetaminophen or ibuprofen, and antiviral medications like oseltamivir (Tamiflu) 75mg twice daily for 5 days may be prescribed, especially if started within 48 hours of symptom onset, as recommended by the AAP in 2024 1.

Discharge Instructions

To ensure a smooth recovery and prevent the spread of influenza B, the following discharge instructions should be provided:

• Rest and stay hydrated by drinking plenty of fluids
• Take over-the-counter medications as needed for symptom relief
• Wash hands frequently, cover coughs and sneezes, and avoid close contact with others to prevent transmission
• Monitor for worsening symptoms, such as difficulty breathing, chest pain, confusion, or persistent high fever, and seek medical attention immediately if they occur

Antiviral Medications

Oseltamivir (Tamiflu) is the preferred antiviral medication for the treatment of influenza B, and it should be started within 48 hours of symptom onset for optimal effectiveness 1. The recommended dosage is 75mg twice daily for 5 days, although the dosage may vary depending on the patient's age and weight.

Prevention of Transmission

To prevent the transmission of influenza B, patients should:

• Avoid close contact with others, especially those who are at high risk of complications, such as the elderly, young children, and people with certain chronic health conditions
• Cover their mouth and nose with a tissue when coughing or sneezing, and dispose of the tissue properly
• Wash their hands frequently with soap and water, or use an alcohol-based hand sanitizer if soap and water are not available
• Avoid sharing utensils, dishes, or other personal items with others

Follow-up Care

Patients should follow up with their healthcare provider if their symptoms worsen or if they experience any complications, such as pneumonia or bronchitis. They should also follow up with their healthcare provider to confirm that they are no longer contagious and to receive any necessary further treatment or guidance. According to the CDC guidelines, antiviral treatment with oseltamivir or zanamivir is recommended for patients with influenza within 48 hours of symptomatic onset, and the indicated duration of treatment is 5 days 1.

From the FDA Drug Label

For subjects infected with type B virus, the median time to improvement of influenza symptoms was 75 hours in the XOFLUZA group (95% CI of 67,90) compared to 101 hours in the placebo group (95% CI of 83,116).

The discontinuation (D/C) instructions for influenza B are not explicitly stated in the provided drug label. However, the median time to improvement of influenza symptoms for subjects infected with type B virus was 75 hours in the XOFLUZA group.

• Key points:
  • Median time to improvement of influenza symptoms for type B virus: 75 hours
  • No explicit D/C instructions for influenza B are provided in the label 2

From the Research

D/C Instructions for Influenza B

• The treatment of influenza B can be managed with antiviral agents such as zanamivir and oseltamivir, which have been approved by the US Food and Drug Administration 3.
• These neuraminidase inhibitors work by inactivating viral neuraminidase, an enzyme responsible for cleaving sialic acid residues on newly formed virions, resulting in aggregation of virions on the surface of the host cell and limiting the extent of infection 3.
• Clinical studies have shown that neuraminidase inhibitors can decrease the median duration of influenza-related symptoms by approximately 1 day if initiated within 48 hours of the onset of symptoms of influenza 3.
• Other neuraminidase inhibitors such as laninamivir and peramivir have also been shown to be effective in treating influenza B, with peramivir alleviating fever and other symptoms sooner than zanamivir and oseltamivir in some studies 4.
• The clinical effectiveness of these neuraminidase inhibitors can vary, with some studies suggesting that the duration of fever after administration of the first dose of the NAI is shorter in older patients and in patients with influenza A infection than in patients with influenza B infection 5.
• The emergence of resistance to neuraminidase inhibitors is a concern, with some clinical cases of influenza viruses harboring single or multiple NA substitutions or deletions conferring a cross-resistance phenotype to oseltamivir and zanamivir reported, mostly in immunocompromised individuals 6.
• Existing recommendations for the use of anti-influenza drugs, including neuraminidase inhibitors, vary by country and are summarized in statements and guidelines of medical societies, such as the German influenza pandemic preparedness plan 7.