Treatment of Triple Infection: COVID-19, Influenza B, and Streptococcal Infection
Yes, you should start two antivirals—one for COVID-19 and one for influenza B—while also treating the streptococcal infection with appropriate antibiotics. 1
Antiviral Treatment Strategy
Influenza B Treatment
- Start oseltamivir 75 mg orally twice daily for 5 days immediately for confirmed influenza B infection 1
- Treatment is most effective when initiated within 48 hours of symptom onset, though benefits persist beyond this window 2
- At age 64, this patient is at higher risk for complications and warrants prompt antiviral therapy 2
COVID-19 Treatment
- Follow CDC or local health authority guidelines for COVID-19 antiviral therapy based on this patient's specific risk factors including age (64 years), comorbidities, and vaccination status 1
- Available COVID-19 antivirals should be initiated according to standard protocols for outpatients at risk of progression 1
Rationale for Dual Antiviral Therapy
- The 2023 Blood Cancer Journal consensus explicitly recommends treating both influenza and SARS-CoV-2 according to standard guidelines when co-infection is confirmed 1
- Co-infection with influenza and COVID-19 occurs in approximately 4-6.6% of COVID-19 cases and is associated with elevated risk for poor outcomes compared to mono-infection 3, 4
- Each virus requires its specific antiviral agent—oseltamivir has no activity against coronaviruses, and COVID-19 antivirals have no activity against influenza 3, 5
Bacterial Infection Management
Streptococcal Treatment
- Initiate appropriate antibiotics for the streptococcal infection based on the site and severity of infection 2
- The 2023 Taiwan guidelines recommend comprehensive microbiologic workup before empirical antibiotics to facilitate appropriate targeting 2
- Antibiotics should not be withheld while awaiting culture results if clinical suspicion is high 2
Critical Monitoring Parameters
Follow-up Schedule
- Schedule follow-up at 48-72 hours to assess clinical response to all three treatments 1
- Monitor for clinical improvement in respiratory symptoms, fever resolution, and overall functional status 1
Safety Considerations
- Check baseline renal and hepatic function before initiating antivirals, as dose adjustments may be needed 2
- Be aware of potential drug-drug interactions, particularly if the patient is on anticoagulation or other chronic medications 2
- Monitor for adverse effects including gastrointestinal symptoms with oseltamivir and potential interactions with COVID-19 antivirals 2
Common Pitfalls to Avoid
- Do not delay influenza treatment waiting for COVID-19 test results or vice versa—treat both infections simultaneously when co-infection is confirmed 1
- Do not use oseltamivir alone expecting it to treat COVID-19—it is completely ineffective against SARS-CoV-2 3, 5
- Do not withhold antibiotics for documented streptococcal infection due to concerns about polypharmacy—bacterial co-infection requires appropriate antimicrobial coverage 2
- Avoid empirical antibiotics without clear bacterial infection evidence, but in this case with confirmed strep, treatment is indicated 2