What are the discharge instructions for a patient with influenza A?

Discharge Instructions for Influenza A

Patients with influenza A should expect illness resolution within 7 days, but must remain vigilant for warning signs requiring immediate medical attention, practice strict infection control measures, and understand when antiviral therapy is beneficial. 1

Expected Illness Course and Recovery Timeline

• The acute illness typically resolves within 7 days, though cough, malaise, and fatigue commonly persist for several weeks after the acute phase. 1
• This prolonged recovery is normal and does not necessarily indicate complications, though persistent or worsening symptoms warrant re-evaluation. 1

Warning Signs Requiring Immediate Medical Attention

Seek urgent care immediately if you develop any of the following:

• Respiratory distress: increasing shortness of breath, respiratory rate >30 breaths/min, or difficulty breathing 2
• Persistent high fever: temperature >37.8°C (100°F) lasting more than 4 days 2
• Hemodynamic instability: heart rate >100 beats/min, systolic blood pressure <90 mmHg, or signs of shock 2
• Hypoxia: oxygen saturation <90% or cyanosis (bluish discoloration of skin) 2
• Neurological changes: altered mental status, confusion, or drowsiness 2
• Severe dehydration: inability to maintain oral intake or vomiting for more than 24 hours 2
• Worsening after initial improvement: recrudescent fever or increasing shortness of breath suggesting bacterial superinfection 2, 1

Infection Control and Preventing Transmission to Others

Hand hygiene is the single most effective measure to prevent spread:

• Wash hands thoroughly with soap and water or use alcohol-based hand sanitizer, particularly after coughing or sneezing. 2, 1, 3
• If hands are visibly soiled, soap and water is superior to alcohol-based sanitizers. 2, 3

Practice respiratory etiquette:

• Cover your nose and mouth with a tissue when coughing or sneezing, and dispose of the tissue immediately. 2, 1, 3
• If no tissue is available, cough or sneeze into your elbow (not your hands). 1, 3
• Wear a surgical mask if you must be around others, especially in common areas. 2, 3

Isolation and activity restrictions:

• Stay home and avoid contact with others, especially high-risk individuals (elderly, pregnant women, immunocompromised), until you are fever-free for 24 hours without using fever-reducing medications. 2, 1, 3
• Remain off work while symptomatic to prevent transmission to colleagues. 1, 3
• Maintain at least 3 feet of separation from others when isolation is not possible. 2, 3

Antiviral Medication Information

If you were prescribed oseltamivir (Tamiflu):

• Take 75 mg twice daily for 5 days as prescribed. 2
• Oseltamivir is most effective when started within 48 hours of symptom onset, ideally within 24 hours, and reduces illness duration by approximately 24 hours. 2, 1, 4
• Take with food to reduce nausea, the most common side effect. 5, 6
• Complete the full 5-day course even if you feel better. 2
• If you have kidney disease (creatinine clearance <30 mL/min), your dose should be reduced to 75 mg once daily. 2

If you were NOT prescribed antivirals:

• Antivirals are most beneficial when started within 48 hours of symptom onset. 2, 1
• For future episodes, consider having a prescription ready to start at the first sign of symptoms if you are at high risk for complications. 1

Antibiotic Use: When They Are NOT Needed

Antibiotics are NOT routinely needed for uncomplicated influenza with acute bronchitis in previously healthy adults. 2, 1

Antibiotics should only be considered if:

• You develop worsening symptoms after initial improvement (recrudescent fever or increasing shortness of breath), suggesting bacterial superinfection. 2, 1
• You are at high risk of complications and develop lower respiratory tract features. 2

Medication Safety

If using over-the-counter decongestants:

• Afrin (oxymetazoline) or similar nasal decongestant sprays should NOT be used for more than 3 consecutive days to avoid rebound congestion. 1

Fever-reducing medications:

• Acetaminophen or ibuprofen may be used to reduce fever and relieve body aches as needed.
• Remember: you must be fever-free for 24 hours WITHOUT using these medications before returning to work or normal activities. 2, 1, 3

Follow-Up Care

No routine follow-up is needed for uncomplicated cases in previously healthy adults. 1

Self-monitor for warning signs and seek care if:

• Symptoms worsen or fail to improve after 7 days. 1
• Any of the warning signs listed above develop. 2, 1

For patients with chronic conditions:

• Follow-up clinical review should be considered if you suffered significant complications or worsening of underlying disease, either with your primary care provider or in a hospital clinic. 2

Prevention for Future Influenza Seasons

Annual influenza vaccination is recommended for all adults and is the most effective prevention strategy. 2, 1, 7

• Vaccination should be obtained before the next influenza season, even though it won't help with your current infection. 1
• If you are unvaccinated, consider getting the vaccine now for protection against future exposures during the current influenza season. 7

Household Contacts and Exposure

If household members develop symptoms:

• They should seek medical attention promptly, as antiviral treatment is most effective when started within 24-48 hours of symptom onset. 2, 1, 7
• High-risk household contacts (elderly, pregnant, immunocompromised, chronic medical conditions) may benefit from antiviral prophylaxis with oseltamivir 75 mg once daily for 10 days. 7

Common Pitfalls to Avoid

• Do not stop isolation prematurely: You remain contagious for approximately 5 days after symptom onset, and potentially longer if immunocompromised. 2
• Do not rely solely on feeling better: You must be fever-free for 24 hours without fever-reducing medications before ending isolation. 2, 1, 3
• Do not demand antibiotics: They will not help viral influenza and may cause unnecessary side effects and antibiotic resistance. 2, 1