What medications are prescribed for a 13-year-old female patient with influenza (flu) and cough?

Treatment for a 13-Year-Old Female with Influenza and Cough

For a 13-year-old with influenza and cough, prescribe oseltamivir 75 mg orally twice daily for 5 days, initiated as soon as possible and ideally within 48 hours of symptom onset. 1, 2, 3

Antiviral Treatment

Primary Medication: Oseltamivir

• Oseltamivir is the antiviral drug of choice for managing influenza infections in adolescents, with activity against both influenza A and B viruses 4, 1
• The standard dosage for patients weighing more than 40 kg (which includes most 13-year-olds) is 75 mg orally twice daily for 5 days 1, 2, 3, 5
• Oseltamivir is available as capsules or oral suspension (6 mg/mL concentration); for a 13-year-old, capsules are typically appropriate 1, 5
• Administer with food to reduce gastrointestinal side effects, which occur in approximately 10-15% of patients 3, 6

Timing is Critical

• Treatment must be initiated within 48 hours of symptom onset for maximum benefit, reducing illness duration by approximately 36 hours (26% reduction) 1, 6, 7
• Treatment started within 12 hours reduces illness duration by an additional 74.6 hours compared to treatment at 48 hours; within 24 hours provides an additional 53.9 hours of benefit 6
• Do not delay treatment while waiting for confirmatory influenza test results—clinical judgment based on symptoms and local influenza activity should guide immediate treatment decisions 1, 3

Expected Benefits

• Oseltamivir reduces the duration of influenza symptoms and fever by approximately one day compared to placebo 4
• The medication decreases the risk of complications including acute otitis media by 34%, as well as bronchitis, pneumonia, and sinusitis 2, 6, 8
• Treatment can reduce hospitalization risk and hasten return to normal activity levels 1, 8

Cough Management

Symptomatic Treatment

• For cough associated with influenza, supportive care is the primary approach while the antiviral medication addresses the underlying viral infection 1
• Ensure adequate hydration throughout the illness course 1
• Antibiotics should NOT be initiated routinely—only add antibacterial therapy if there is clear evidence of secondary bacterial infection (e.g., persistent high fever beyond 3-4 days, worsening symptoms after initial improvement, purulent sputum with clinical deterioration) 1

When to Consider Antibiotics

• If secondary bacterial infection develops, first-line antibiotics for adolescents include amoxicillin-clavulanate 1
• Signs suggesting bacterial superinfection include: fever persisting beyond 3-4 days or returning after improvement, significantly worsening respiratory symptoms, chest pain with breathing, or purulent sputum production 1

Safety Profile and Side Effects

Common Adverse Effects

• Vomiting is the most frequent side effect, occurring in approximately 5-15% of patients, but is generally mild and transient 1, 6, 7
• Nausea occurs in about 10% of patients and typically resolves within 1-2 days 6, 8
• Taking oseltamivir with food significantly reduces these gastrointestinal symptoms 3, 6, 8

Safety Reassurance

• Despite historical concerns, controlled clinical trials and ongoing surveillance have failed to establish a link between oseltamivir and neurologic or psychiatric events 1, 3
• Oseltamivir is FDA-approved for treatment in patients 2 weeks of age and older, with an excellent safety profile in adolescents 1, 5

Critical Pitfalls to Avoid

• Do not wait for laboratory confirmation during influenza season before initiating treatment in symptomatic patients—clinical diagnosis is sufficient 1, 3
• Do not prescribe amantadine or rimantadine, as high levels of resistance persist and these drugs should not be used unless resistance patterns change significantly 4, 1
• Ensure the full 5-day course is completed even if symptoms improve earlier 3, 5
• Do not use antibiotics prophylactically or for uncomplicated influenza without evidence of bacterial superinfection 1

Alternative Antiviral Options

• Zanamivir (inhaled) is an acceptable alternative for patients 7 years and older who cannot tolerate oseltamivir, but is more difficult to administer and should be avoided in patients with underlying respiratory disease like asthma 4, 1
• Intravenous peramivir is approved for acute uncomplicated influenza in patients 2 years and older but is typically reserved for hospitalized patients or those unable to take oral medications 1

Warning Signs Requiring Immediate Medical Attention

Parents should be instructed to seek immediate care if the patient develops: 1

• Difficulty breathing, fast breathing, or chest retractions
• Fever persisting beyond 3-4 days or returning after a period of improvement
• Altered mental status, extreme irritability, or seizures
• Signs of dehydration (decreased urination, dry mouth, dizziness)
• Worsening symptoms after initial improvement