From the Guidelines
The treatment plan for influenza (flu) involves the use of antiviral medications, such as oseltamivir, zanamivir, and peramivir, to reduce morbidity and mortality.
Key Points
- Antiviral treatment should be started as soon as possible after illness onset, ideally within 48 hours, but can still be beneficial when initiated later in the course of a progressive, symptomatic illness 1.
- Oseltamivir is the most commonly recommended antiviral medication, with dosing recommendations varying by age and weight, including:
- Children 12 months and older: 30-75 mg twice daily for treatment, and 30-75 mg once daily for chemoprophylaxis 1.
- Infants 9-11 months: 3.5 mg/kg per dose, twice daily for treatment, and 3.5 mg/kg per dose, once daily for chemoprophylaxis 1.
- Term infants 0-8 months: 3 mg/kg per dose, twice daily for treatment, and 3 mg/kg per dose, once daily for chemoprophylaxis 1.
- Zanamivir and peramivir are alternative antiviral medications, with specific dosing recommendations and indications, including:
- Antiviral treatment is recommended for:
- Children hospitalized with suspected influenza 1.
- Children with severe, complicated, or progressive illness attributable to influenza, regardless of duration of symptoms 1.
- Children with suspected influenza (of any severity) and at high risk of complications, including those with chronic medical conditions, immunosuppression, or age <2 years 1.
- Clinical judgment is important in treatment decisions, taking into account the patient's disease severity, age, underlying medical conditions, likelihood of influenza, and time since onset of symptoms 1.
From the Research
Treatment Plan for Influenza (Flu)
The treatment plan for influenza (flu) typically involves a combination of pharmacological and supportive care strategies.
- The primary treatment approach is the use of neuraminidase inhibitors (NAIs), such as oseltamivir, which has been shown to be effective in reducing the duration and severity of symptoms when started early in the course of the illness 2, 3, 4, 5.
- Supportive care is also crucial, particularly in patients with severe respiratory failure, and may include optimization of ventilatory strategies, noninvasive ventilation, and high-flow nasal oxygen 2.
- The use of corticosteroids is generally not recommended, as it has been associated with increased mortality and bacterial superinfection 4.
- Annual influenza vaccination is also recommended as a preventive measure for all individuals six months and older who do not have contraindications 5, 6.
Pharmacological Treatment
- Oseltamivir is the most commonly used NAI and is recommended to be started as soon as possible, ideally within 48 hours of symptom onset 3, 4, 5.
- Other NAIs, such as zanamivir, may be considered in patients who are resistant to oseltamivir or have severe disease 4.
- The use of newer antiviral agents is being investigated, but their efficacy and safety have not been fully established 2, 3.
Supportive Care
- Supportive care is critical in managing patients with severe influenza, particularly those with respiratory failure 2.
- Optimization of ventilatory strategies, including noninvasive ventilation and high-flow nasal oxygen, may be beneficial in selected patients 2.
- Early enteral oseltamivir is also recommended as part of supportive care 2.