At-Home Treatment for Influenza A
Immediate Supportive Care
For most patients with influenza A, the cornerstone of at-home treatment is supportive care with antipyretics for fever control and adequate hydration, while considering antiviral therapy with oseltamivir if started within 48 hours of symptom onset. 1, 2
Fever and Symptom Management
- Use acetaminophen (paracetamol) or ibuprofen for fever and discomfort relief in adults and children over 6 months of age 1, 3
- Never use aspirin in children under 16 years of age due to the risk of Reye syndrome 4, 1
- For children, acetaminophen dosing is 15 mg/kg per dose every 4-6 hours (maximum 4 doses in 24 hours) 5
- For children, ibuprofen dosing is 10 mg/kg per dose every 6-8 hours (maximum 3 doses in 24 hours) 5
- Alternating acetaminophen and ibuprofen every 4 hours may provide superior fever control compared to either medication alone, though careful dose tracking is essential to avoid exceeding maximum recommended doses 6
Hydration and Rest
- Maintain adequate oral fluid intake throughout the illness - this is crucial for recovery 1
- Rest at home until fever-free for at least 24 hours without antipyretics 7
- For children unable to maintain oral intake due to breathlessness or fatigue, seek medical evaluation 1
Antiviral Treatment Considerations
When to Use Oseltamivir
Oseltamivir should be initiated within 48 hours of symptom onset for maximum benefit, though treatment within 24 hours provides the greatest reduction in illness duration. 4, 7
High-Priority Candidates for Antiviral Treatment:
- All hospitalized patients with influenza, regardless of illness duration 4
- Children younger than 2 years and adults ≥65 years 4
- Pregnant women and those within 2 weeks postpartum 4
- Persons with chronic medical conditions (heart disease, lung disease, diabetes, immunosuppression, etc.) 4
- Patients with severe or progressive illness at any time point 4
Oseltamivir Dosing:
Adults and adolescents (≥13 years): 75 mg orally twice daily for 5 days 2
Children (weight-based dosing): 4, 2
- ≤15 kg: 30 mg twice daily
- 15.1-23 kg: 45 mg twice daily
- 23.1-40 kg: 60 mg twice daily
40 kg: 75 mg twice daily
Infants (2 weeks to <1 year): 3 mg/kg twice daily for 5 days 4, 2
- Oseltamivir may be taken with or without food, though taking it with food may improve tolerability 2
- Treatment reduces illness duration by approximately 24 hours in otherwise healthy patients and may decrease risk of complications 7
When to Seek Medical Attention
Warning Signs Requiring Immediate Evaluation:
Adults: 4
- Difficulty breathing or shortness of breath
- Persistent chest pain or pressure
- Confusion or altered mental status
- Severe or persistent vomiting
- Dizziness or inability to stand
- Symptoms that improve then suddenly worsen
- Signs of respiratory distress (markedly raised respiratory rate, grunting, intercostal recession)
- Cyanosis (bluish discoloration)
- Severe dehydration
- Altered consciousness or drowsiness
- Complicated or prolonged seizures
- Vomiting >24 hours
- Fever >38.5°C with chronic medical conditions
Important Caveats
- Do not use amantadine or rimantadine - current circulating influenza A strains show widespread resistance to these medications 4, 7
- Antiviral treatment should not be delayed while awaiting laboratory confirmation if influenza is clinically suspected 4
- Most children with mild coughs and low-grade fevers can be managed at home without antivirals 4, 1
- Oseltamivir is not a substitute for annual influenza vaccination 2
- Resistance to oseltamivir can develop during treatment or prophylaxis, though this remains uncommon 8