What are the recommended home treatment options for a patient with a mild case of influenza B?

Home Treatment for Influenza B

For mild influenza B at home, provide symptomatic management with antipyretics and adequate hydration, and consider oseltamivir 75 mg twice daily for 5 days only if the patient presents within 48 hours of symptom onset and has high-risk features; otherwise, antivirals are not necessary for uncomplicated illness. 1, 2

Antiviral Treatment Decision

• Oseltamivir should only be initiated if ALL of the following criteria are met: acute influenza-like illness, fever >38°C, and symptom onset within 48 hours 3, 2
• The standard dose is oseltamivir 75 mg orally twice daily for 5 days 3, 2
• For otherwise healthy adults with mild influenza B beyond 48 hours of symptom onset, do NOT initiate antivirals 1, 4
• High-risk patients (age ≥65 years, pregnant women, chronic medical conditions, immunocompromised) should receive oseltamivir even if presenting beyond 48 hours, as they benefit from treatment at any stage of illness 1, 5
• Patients who cannot mount adequate febrile response (elderly, immunocompromised) may still qualify for antiviral treatment despite lack of documented fever 3, 5

Symptomatic Management

• Use acetaminophen or ibuprofen for fever control and body aches 3, 6
• Never use aspirin in children under 16 years of age due to Reye's syndrome risk 3, 6
• Ensure adequate oral fluid intake to maintain hydration 3
• Rest at home and limit movement to essential purposes only 3

When Antibiotics Are NOT Needed

• Do NOT routinely add antibiotics for uncomplicated influenza B without evidence of bacterial superinfection 3, 1, 6
• Previously well adults with acute bronchitis complicating influenza, in the absence of pneumonia, do not require antibiotics 3

Red Flags Requiring Medical Evaluation

Seek immediate medical attention if any of the following develop:

• Worsening symptoms after initial improvement (recrudescent fever) 3, 1, 5
• New or increasing shortness of breath or difficulty breathing 3, 5
• Productive cough with purulent sputum 1, 5
• Respiratory rate ≥30 breaths per minute 6, 5
• Oxygen saturation <92% 6, 5
• Confusion or altered mental status 6, 5
• Inability to maintain oral intake or severe dehydration 3, 5
• Persistent vomiting >24 hours 3
• Chest pain or pressure 7
• Hemoptysis (coughing up blood) 5

When to Add Antibiotics

Antibiotics should be added if bacterial superinfection develops, indicated by:

• Worsening symptoms after initial improvement 3, 1, 5
• New or worsening dyspnea with focal chest findings on examination 1, 5
• Productive cough with purulent sputum 1, 5
• Radiographic evidence of pneumonia 1, 6, 5

For non-severe bacterial pneumonia complicating influenza, use oral co-amoxiclav (amoxicillin-clavulanate) 625 mg three times daily as first-line therapy 3, 6, 5

Infection Control at Home

• Wash hands frequently with soap and water or use alcohol-based hand sanitizer 3, 8
• Cover coughs and sneezes with tissue or elbow 3, 8
• Stay home and avoid close contact with others until fever-free for 24 hours without antipyretics 3, 8
• Wear a surgical mask if movement outside the room is necessary 3
• Clean and disinfect frequently touched surfaces 8

Common Pitfalls to Avoid

• Do not delay seeking medical attention if red flag symptoms develop, as delays beyond 4 hours in starting antibiotics for pneumonia increase mortality 6
• Do not use antivirals beyond 48 hours in otherwise healthy patients with uncomplicated illness, as there is no demonstrated benefit 1, 4
• Do not use macrolide monotherapy for influenza-related pneumonia; combination therapy with a beta-lactam is required for severe disease 6
• Do not assume lack of fever rules out influenza in elderly or immunocompromised patients 3, 5