What is the best course of action for a patient with Flu A who is feeling better?

Management of a 27-Year-Old Active Duty Male with Flu A Who Is Now Feeling Better

If this patient is truly feeling better and has no concerning symptoms, no further treatment is needed—he can return to duty with standard precautions for contagiousness. 1

Key Clinical Assessment

The critical question is whether "feeling better" means complete resolution or just improvement. You need to specifically assess for:

• Shortness of breath at rest or with minimal activity 2
• Painful or difficult breathing 2
• Coughing up bloody sputum 2
• Recrudescent fever (started to feel better, then fever returned) 2, 1
• Drowsiness, disorientation, or confusion 2
• Persistent fever for 4-5 days without improvement 2

If any of these red flags are present, he needs immediate re-evaluation for complications, particularly influenza-related pneumonia. 2, 1

Antiviral Therapy Considerations

For this patient who is now feeling better:

• Oseltamivir is NOT indicated if he is beyond 48 hours from symptom onset and is improving, as he is a previously healthy adult without high-risk features 1, 3
• The FDA label specifies oseltamivir is indicated for patients "who have been symptomatic for no more than 48 hours" 3
• Even if he were still within the 48-hour window, oseltamivir only reduces illness duration by 24-36 hours in otherwise healthy adults 4

The only scenario where late antiviral treatment (>48 hours) would be considered is if he were severely ill, hospitalized, or immunocompromised—none of which apply here. 1, 4

Antibiotic Considerations

Antibiotics are NOT indicated for this patient unless specific complications develop 2, 1:

• Previously healthy adults with uncomplicated influenza do not require antibiotics 2, 1
• Antibiotics should only be considered if he develops worsening symptoms after initial improvement, particularly recrudescent fever or increasing breathlessness 2
• If pneumonia is suspected clinically, first-line oral therapy would be co-amoxiclav or doxycycline to cover S. aureus, S. pneumoniae, and H. influenzae 2, 1

Return to Duty Guidance

He can return to duty once:

• Fever has been absent for 24 hours without antipyretics 1
• He is clinically improving and has no red flag symptoms 2, 1
• He understands he may still be contagious for up to 5-7 days from symptom onset 5

Common Pitfalls to Avoid

• Do not prescribe oseltamivir "just in case" beyond 48 hours in a healthy, improving patient—there is no benefit 1, 4, 3
• Do not prescribe antibiotics prophylactically—this promotes resistance without benefit 2, 1
• Do not clear him for duty if he still has fever—he remains contagious 1
• Do not assume vaccination failure—annual flu shots reduce severity even when they don't prevent infection entirely 3, 5

When to Bring Him Back

Instruct him to return immediately if he develops:

• Any of the red flag symptoms listed above 2
• Worsening after initial improvement 2, 1
• Inability to maintain oral hydration 1