Treatment of Influenza A Progression

Introduction to Treatment

The Centers for Disease Control and Prevention recommends initiating antiviral treatment with a neuraminidase inhibitor immediately for any patient with progressive influenza A, regardless of time since symptom onset, as early treatment reduces morbidity and mortality 1, 2

Mandatory treatment groups include patients with progressive, severe, or complicated influenza illness of any duration, hospitalization for influenza, and severe disease manifestations, according to the Centers for Disease Control and Prevention 1, 2, 3
High-risk patients requiring treatment include children <2 years and adults ≥65 years, pregnant women and postpartum women, immunocompromised patients, and patients with chronic conditions, as recommended by the Centers for Disease Control and Prevention 2, 3, 4

The Infectious Diseases Society of America recommends oseltamivir 75 mg orally twice daily for 5 days as a first-line treatment option for adults and adolescents ≥13 years 1, 2
Alternative treatment options include zanamivir and peramivir, according to the Infectious Diseases Society of America 1, 2

Treatment should begin as soon as possible, ideally within 48 hours of symptom onset, but should not be withheld in severely ill or hospitalized patients even if >48 hours have passed since symptom onset, as recommended by the Centers for Disease Control and Prevention 3, 4, 5

The Infectious Diseases Society of America recommends empirically treating bacterial coinfection in addition to antiviral therapy when patients present with initial severe disease, clinical deterioration after initial improvement, or failure to improve after 3-5 days of antiviral treatment 1, 2

The Centers for Disease Control and Prevention advises against using corticosteroids as adjunctive therapy for seasonal influenza treatment 1
The Centers for Disease Control and Prevention also advises against using amantadine or rimantadine due to high resistance rates among circulating influenza A viruses 8